The Perfect Combo- Invest your money in a nuclear camera set up that is profitable!

THE PERFECT COMBO

In growing numbers, Canadian nuclear medicine clinics are quickly realizing that the most profitable clinic camera set up is a Spectrum Dynamics Cardiac CZT along with a refurbished dual head general purpose camera.

                                   Spectrum Dynamics             GE Millenium MG                                                        

Spectrum Dynamics Benefits:

• Fast results: The D-SPECT can acquire a complete gated SPECT study in as little as two minutes, improving department workflow, enhancing patient compliance and reducing the chance of patient motion.

• Image quality: D-SPECT’s count rich data sets combined with a proprietary reconstruction algorithm to ensure optimal spatial resolution and exceptional image quality.

• Dose reduction: The extremely high sensitivity of the D-SPECT detectors allows for dramatic reductions in injected dose. Patients and staff benefit from the lower radiation dose.

Refurbished Nuclear Camera Benefits:

• Reduced cost: The price of a refurbished gamma camera can be more than half the cost of a new nuclear camera.

• Quality: Our refurbished nuclear medicine equipment strictly adheres to good refurbishment practices and quality requirements, ensuring our systems are both as safe and effective as when they were new.

• Warranty: All refurbished cameras come with a full one year warranty, installation and training.

Ringing in the new year with another successful fully refurbished nuclear camera install!

GE Millennium MG just installed in Western, Ontario

Refurbished GE Millennium MG

Since 1999 we have been offering quality refurbished turn-key gamma cameras to the Canadian healthcare market.

We would welcome the opportunity to provide you with a quote for your next nuclear camera.

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

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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See original story

GOOGLE HEALTH ACCUSED OF INACCURACY IN ELECTRONIC MEDICAL RECORDS

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

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

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

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

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

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

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

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

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

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

Read original article.

CLINICAL INFORMATION ACCESS IMPACTS RADIOLOGY INTERPRETATION

September 18, 2008 | Clinical Studies

The majority of radiologists at eight academic medical centers are dissatisfied with their ability to access clinical patient information at the time of interpretation, according to results from a report published online before print in the Journal of Digital Imaging. The report also indicates that the lack of access to pertinent clinical patient data may be a critical element that limits the accuracy of the radiologist’s diagnostic decision-making process.

“Given the increasing volume of radiological exams, the decreasing frequency of direct communication with the referring provider, and the distribution of patient data over many clinical systems, radiologists often do not have adequate clinical information at the time of interpretation,” the authors wrote.

William W. Boonn, MD, and Curtis P. Langlotz, MD, PhD, of the department of radiology at the Hospital of the University of Pennsylvania in Philadelphia, designed the survey. Among its 27 questions were an assessment of the IT environment in which the respondent practiced, including how radiology orders were typically processed and how images were displayed for interpretation. In addition, opinions about acquisition and access to relevant clinical patient information, both at the time of the examination and in follow-up, were obtained.

A total of 139 radiologists responded to the survey, with the vast majority (90 percent) practicing in an academic setting. Slightly more than half (54 percent) were attending radiologists; the remainder of the survey cohort was comprised of radiology fellows and residents.

The survey found that 72 percent of the respondents reported that they frequently needed more clinical information about their patients than was available at the time of study interpretation. More importantly, 87 percent acknowledged that additional clinical information was significant and that this information could change or modify the interpretive report.

“Of the available sources of information, radiologists reported that outside radiology reports, admission notes and progress notes typically yielded their preferred clinical information,” the authors stated. “However, despite their desire for these information sources, they reported using them less than 15 percent of the time.”

More than half (53 percent) of the respondents indicated that their reasons for not seeking access to additional clinical information was that such efforts were too time consuming.

Obtaining follow-up data on patients proved to be equally problematic for radiologists. The authors reported that clinical follow-up information was predominantly obtained either through discussions with the referring clinician or through subsequent imaging or pathology reports.

“Our findings demonstrate that most radiologists want more clinical information when interpreting images and that this information would impact their report, but they are discouraged by the time it takes to access this information,” the authors noted. “In addition, current mechanisms for monitoring necessary patient follow-up are inadequate.”

Boonn and Langlotz observed that many hospitals have multiple different systems used to access clinical data, which presents challenges to radiologists through multiple logins and user interfaces. In addition, legacy systems may not be fully integrated throughout the healthcare enterprise due to nonstandard, proprietary interfaces.

The pair believes that their survey indicates the critical need for an integrated application for the automatic identification, selection, retrieval and display of pertinent patient information at the time of interpretation. In addition, this application needs to provide alerts and reminders for patient follow-up.

“Together, these applications would have a significant impact on the satisfaction of radiologists, the quality of radiology interpretations, and thereby on the quality of care,” they wrote.

Read Original Article

PROVIDER E-HEALTH PORTAL ALLOWS REGIONAL HOSPITALS TO SHARE DATA

In 2005, the Ontario government decided to transfer the operation of Georgetown Hospital from William Osler Health Centre to Halton Healthcare Services. During the transition, historical clinical data was left on the Osler system, and after the transfer, many of the physicians remained at Georgetown and still provided service to Osler. In order to provide clinicians with access to patient data from both organizations, a “provider portal” was deemed the best approach to meet the clinical data sharing needs of physicians and clinicians.

The IT staff from Halton and Osler worked together to identify available vendor solutions, and during the request for proposals process, three other hospitals — Credit Valley Hospital, Trillium Health Centre and Headwaters Health Care — became involved in the evaluation because it was felt they might join the network later. In 2006, Credit Valley acquired a licence for the provider portal; Trillium and Headwaters followed in 2008.

In a presentation at the eHealth Summit, Dan Germain, vice-president, CFO and CIO at Credit Valley, explained how the Rapid Electronic Access to Clinical Health Information (REACH) system was deployed. The REACH provider portal (provided by Medseek) is a web-based Portal solution that consolidates clinical patient data from disparate vendor systems (in real-time) into a unified, patient-centric view regardless of site location.

Currently, the REACH portal allows viewing of allergies and alerts, laboratory results, pharmacy medications, pathology reports, radiology images and reports, ECG tracings, clinical orders, clinical documentation, scanned paper records, rounding reports, and other clinical data. It’s developed on a federated data model, where data is stored at each entity. The REACH server consolidates the clinical data in real time, presenting it to the user in a web browser in milliseconds. It's similar to a Health Information Access Layer (HIAL.)

The REACH portal also employs an Enterprise Master Patient Index (EMPI.) However, once access is granted to use the Ontario EMPI, REACH will interface to that application. The Credit Valley Hospital's IT team was impressed by the speed with which this application was deployed, Germain said. Implementation was accomplished over a few months, and in the words of users, testing was similar to a systems upgrade. Since the application is very intuitive, users required little if any training.

Before deployment at CVH, a privacy impact assessment was performed. The only significant recommendation was to mandate the use of a pass-code keyfob for remote access via the Internet. Since patient-specific data is only stored once, responsibility for data security and integrity remains with each host hospital.

By the spring of this year, William Osler, Halton and Credit Valley were using the provider portal extensively. Every month, hundreds of physicians and clinicians log onto REACH, one-third of whom are users looking at their patients that have been seen at other facilities. There are now over 9,000 views per month. As well as integrating into the Ontario HIAL and EMPI, Germain said future plans for this initiative include additional clinical content such as operating room systems and realtime physiological wave-form monitoring. REACH is also to extend a Patient Portal providing patient's range of other self-care services directly accessible online.

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The 2008 ACUMEME eHEALTH AWARD

The ACUMEME e-HEALTH AWARD is given to Canadian Healthcare delivery organization that has successfully extended e-Health application(s) that further our national objective of a comprehensive, interoperable, and transferrable electronic health record (EHR.) The Award promotes and recognizes the exchange of best practices within the field of e-Health.

ACUMEME is pleased to announce the 2008 e-HEALTH AWARD WINNER is the Rapid Electronic Access to Clinical Health Information (REACH) EHR Viewer Initiative in the Province of Ontario’s Local Health Integration Network’s 5 and 6 respectively. Constituent Hospitals include the Credit Valley Hospital, Halton Healthcare Services, and William Osler Health, Headwaters Health, and Trillium Health Centre.

REACH is shaping the future of patient care in Canada. As the first Integrated LHIN’s, REACH extends a seamless (“read-only”) connection to critical patient information aggregated from multiple vendors and multiple sites. For over 1.8 million Canadians residing in LHIN’s 5&6 this ensures their historical patient data is available along the entire continuum of care---regardless of geographical location. Utilizing state of the art clinical portal technology (provided by vendor MEDSEEK,) the REACH platform intuitively weaves together all existing clinical data and services from 11 Hospital sites into one intuitive, unified, patient-centric view at the point of care. When Physicians, hospitals, labs, pharmacies, clinicians, consumers, and researchers are connected through integrated IT systems—healthcare delivery is safer, more efficient, and value-driven.

REACH promises to have a significant effect on patient safety and wasteful duplication, while extending Canadian’s a regional care system where privacy, security, and confidentiality are respected and easily moderated. Congratulations to REACH (and its member constituents) for winning ACUMEME’s 2008 e-HEALTH AWARD.

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Additional information on the REACH EHR Initiative.

IT Could Cut Canada's Health Care Costs by About $7B Annually

November 13, 2007 | Creation of Canadian electronic health records (EHR) system could save billions in costs annually. President of Canada Health Infoway predicts huge reduction in need for diagnostic tests, fewer days in hospital.

Richard Alvarez, President of Canada Health Infoway, the country's planned health information sharing program -- said that more effective information management through the use of IT could reduce national health care costs by $6 billion to $7 billion Canadian, or about $6.24 billion to $7.29 billion, annually, Charlottetown Guardian reports.

The savings would come from reducing hospitalizations based on unnecessary drug interactions and a reduction in duplicate diagnostic tests, the Guardian reports.

The Canadian federal government plans to invest $1.6 billion Canadian, or about $1.66 billion, into Health Infoway and leverage another $1.6 billion Canadian, or about $1.66 billion, from provincial and territorial governments.

"This is a $10 billion (Canadian) project all told by the time it is completed and we expect that to happen over the next 10 years," Alvarez said.

Alvarez said the nationwide health IT program will "start with hospitals, then pharmacies and community clinics, and probably the last to come on board will be family doctors' offices" (Original article from Charlottetown Guardian, 11/13).

What the @#$% is an Azyxxi?

There’s been a lot of scuttlebut around Microsoft's acquisition of a technology (and company) known as Azyxxi from MedStar Health in Washington, D.C. To clarify, Azyxxi (according to their website) is "a unified health enterprise platform that helps improve cross-organizational access and insight to clinical, administrative, and financial data."

What Pain Points Azyxxi will address in Healthcare IT?
o Improvements are needed in clinical information acquisition, storage, retrieval, sharing, and presentation—an important goal in any health care strategy.
o As we move toward the future, an important first step is simply to get all existing data into the hands of clinicians and other health care professionals.
o In today's hospital enterprise, already-existing information may not readily be available when and where it is needed.
o Best-of-breed systems lack integration, creating an environment in which information is hard to access and harder to aggregate for optimal value.
o Clinicians and administrators need access to data that enables the most informed decisions around patient care and operational performance.

The Microsoft Azyxxi solution
Health care professionals could benefit from the ability to quickly pull this data into a consolidated and customized view, to help enable informed decisions and peak performance. Azyxxi focuses on improving clinical information acquisition, storage, retrieval, sharing, and presentation. Azyxxi sits across most current best-of-breed systems in the hospital. It aggregates patient data so that clinicians can get an instant picture of the data in the hospital's systems. There's no waiting for archived information. Azyxxi aggregates relevant data for one, nearly instantaneous, view. Healthcare workers can maximize the value of information to help make the most informed decisions. Informed decisions can help save your business money and—most importantly—help save patient lives.

Architecture
A hospital or health system typically has a configuration of best-of-breed IT systems that operate independently of each other. One system controls imaging, another manages emergency room systems, yet another addresses operating room management and the list goes on. Azyxxi sits across most current best-of-breed systems in the hospital and aggregates patient data so that clinicians can get an instant picture of the data in the hospital's systems at any time. The information is viewed and analyzed according to the individual needs of the user. Azyxxi customizes the results to help enable the most informed decisions and best patient care.

Existing IT State
You have hard-working, disparate information systems that cannot coordinate to feed you an integrated view of results. This results in frustrated clinicians and administrators who may not have access to all the data they need. Traditional enterprise-wide health IT systems have evolved from transactional systems. In these systems data is organized and locked in strings that have been created to resolve a specific transaction request. System requests are slowed down by the inability to search on individual data components, as the search request must move through all the transaction codes in the system to identify the relevant data pieces—an inefficient process in a business that may depend on timely decisions to help save patient lives.

Why Microsoft Azyxxi is different?
It's seemingly built on a federated-database model similar to MEDSEEK. Your clinicians and administrators need integrated and customized views and analysis of clinical, financial and administrative data. Azyxxi was developed as a solution to data storage and search issues, integrating across multiple best-of-breed health IT systems. It does not replace them.

Results for your health organization
Data is divided into multiple components, clearly identifiable within each transaction. This means the data can be re-organized into multiple buckets to answer a wide variety of queries. Search is fast because it does not require scrolling through thousands of transactions to source the data. Detailed queries and analysis become easier the more you use Azyxxi, as you increase your potential to leverage existing criteria sets and views.

Azyxxi's flexible federated architecture means that it can be customized any number of ways, depending on the user's needs. Much like competitor Medseek's "eConnect" platform, views and workflows can be optimized over time as workflows evolve, making it increasingly valuable the more that it is used. For more information on Microsofts Azyxxi solution, please visit:http://www.azyxxi.com

Pan-Canadian Health Information Privacy and Confidentiality Framework

Canadians expect and have confidence that the privacy and confidentiality of their personal information will be protected when governments use it in the course of providing programs and services. In no field is the maintenance of this trust more critical than in the health sector.

Recognizing the importance of privacy, the Federal/ Provincial/Territorial Conference of Deputy Ministers of Health tasked its Advisory Committee on Information and Emerging Technologies to develop a Pan-Canadian Health Information Privacy and Confidentiality Framework. The objective of the Framework is to respond to Canadians' privacy and confidentiality expectations and to suggest a harmonized set of core provisions for the collection, use and disclosure of personal health information in both the publicly and privately funded sectors. Consistent, or at least more consistent, privacy regimes among jurisdictions would facilitate health care renewal, including the development of electronic health record systems and primary health care reform.

The Framework is a valuable tool to inform and influence any privacy legislative process within jurisdictions affecting personal health information. Since the Personal Information Protection and Electronic Documents Act (PIPEDA) applies in jurisdictions which, unlike Quebec and British Columbia, have not adopted "substantially similar" legislation, the Framework can also serve as a guide to achieving that objective. However, it is also understood that it is only a guide, not a prescription. The actual intent and wording of jurisdictional legislation will ultimately determine whether the legislation can result in an exemption from PIPEDA. Quebec did not participate in the development of the Framework, while Saskatchewan withdrew near the end of the process.

For more information on Pan-Canadian Health Information Privacy and Confidentiality Framework please visit - http://www.hc-sc.gc.ca/hcs-sss/pubs/ehealth-esante/2005-pancanad-priv/index_e.html
Health and the Information Highway Division, Health Canada January 27, 2005

All eHealth PORTALS are not created equal

INTRODUCTION

Canada's health system is a tangled, highly fragmented network that often wastes a great number of resources by duplicating efforts, leaving unaccountable gaps, and failing to build on the strengths of our health professionals and clinical expertise. Even though Canada’s health care delivery carries a significantly higher price tag than more than most other industrialized nations, Canadian’s only receive only about half of the recommended care for that investment. With an aging population, extended wait times, and chronic conditions reaching epidemic proportions, our healthcare system will not survive without radical change.

According to Frost & Sullivan , increasing integration is creating the need for a single point of contact to healthcare IT (HIT) systems, which in turn, is driving the eHealth market. eHealth, the application of web-based information technology to healthcare, can profoundly change the way the business of healthcare is conducted—making it safer, more affordable, and significantly more efficient. However, transforming traditional modes of delivering care will require Health Care Organizations (HCO) to take advantage of the enormous potential offered by information technology in far more complex ways. Previously, eHealth was stalled by interoperability issues and a lack of workflow-driven, secure information exchange. Today however, progressive technology and innovative solutions are enabling unprecedented advancements.

The relatively brief history of Health Information Technology (HIT) has taught organizations the high costs of failure, which has caused Health Care Organizations (HCO’s) to prudently proceed with guarded optimism. Although there is recognition of the benefits of eHealth, when combined with a market already crowded with HIT vendors attempting to help HCO’s realize a return on investment (ROI,) it becomes increasingly difficult to identify a vendor with a meaningful track record. As such, the majority of Health Care Organizations have been watching the progress of vanguard organizations before they commit their time and money.

Waiting to join the eHealth movement has its own disadvantages. Besides prolonging current inefficiencies, laggard organizations may miss an important window of opportunity, and the benefits of adopting eHealth strategies are too great to ignore. For HCO’s determined to take advantage of the current Infoway-driven EHR environment, the next imperative action is to outline an appropriate technical platform for their eHealth strategy.

Fundamentally, organizations are seeking a platform that allows the seamless delivery of information across the continuum of healthcare. Fortunately, this objective can be met without cost-prohibitive, universal replacement of existing HIT. Moving forwards with a portal communications strategy can bind the information technology of disparate facilities and stakeholders into an interactive user community using advanced, but proven, web portal technologies.

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WEB PORTALS: DEFINITION AND DESCRIPTION

From the user perspective, a web portal is any technology that allows an individual or user community to gain convenient access to a broad range of information and services through their web browser. Most HCO’s serve a variety of stakeholder communities, including providers, payers, patients, employees, and consumers. Each of these stakeholder communities benefits from a portal that is targeted specifically to their needs, aggregating information of value for them and allowing them to communicate freely with the host organization and each other.

For the hosting HCO, a portal is an integration tool that incorporates service and data management applications with workflows and business processes to present a unified, personalized, and streamlined gateway to their enterprise for its stakeholders. The HCO establishes a portal strategy to offer timely access to real-time information resulting in better customer service that is accessible from a single point of entry, regardless of which system generates the information or where the information resides. While a provider portal, patient portal, employee portal, and a consumer portal each appear independent of the other, they are clearly interrelated. Since healthcare consumers may be patients, employees, or even providers, their needs will overlap. Therefore, each stakeholder may require access to the others’ data as well as additional common data sources.

A portal solution can serve to aggregate information stored in disparate, incompatible systems using a Service-oriented architecture (SOA). SOA describes a product architecture that allows tight integration with underlying applications, without requiring system interoperability. This also allows users to access software functions independent of the underlying platform and/or programming language. It permits services to be rolled into larger applications that can be incorporated into portals, without locking the enterprise into a specific vendor. While the SOA concept has been around for quite some time, emerging standards-based integration technologies like Web services and XML have just recently made it practical. The benefit for your healthcare organization is clear ---a SOA enables eHealth while protecting the enterprise’s investment in legacy software. As organizations search for viable tactical path to leverage a service-oriented architecture, many can use portal products as a first step.

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eHealth EVOLUTION: BABY STEPS INTO THE FUTURE

The Gartner Group has identified five levels of eHealth development using Portals, the elements that comprise them, and what it takes to move from one level to the next (see illustration Figure 1 below). Health Care Organizations continue to significantly use portal products to build and deploy a variety of customer, citizen, partner and employee-facing enterprise portals. Portals have evolved through four generations of technology and are embarking on their fifth generation. In the beginning, eHealth bore relatively simple websites that provided new levels of information accessibility to healthcare consumers. As the technology evolved to Level 2, searchable directories and more interactive features were added, providing dynamic new options for HCO marketing and administration departments. It was possible to promote classes and services, help people find reliable current health information and appropriate specialists, make human resources information readily available to employees, and collect and manage data using the Internet.

Since Generation 2, portals have leveraged service-oriented (SOA) capabilities. Generation 2 portals provided a rudimentary method of composite application assembly known as interportlet communication. Organizations can use interportlet communication to build composite applications by linking portlets related to a specific business process. This type of composite application is referred to as "on the glass" because the integration is at the presentation layer rather than deep in the business logic. This integration approach is effective for user-driven processes, and advanced enterprise portals use interportlet communication extensively.

Level 3 applications required a broader revolution within healthcare from paper to electronic medical records, which was reliant on emerging data standards and the willingness of HCOs to empower their users with more control and access. Generation 3 portals enabled systems to handle basic Web services. These portal products could consume Web services. The addition of workflow, which is a feature of most portal products, introduced a new way to orchestrate composite applications.

Over time, the experiences of the early adopters and results of pilot projects generated sufficient results to compel cautious HCOs to pursue the promise of eHealth. With Level 3 adoption no longer stalled by technological limitations and the pervasive wait-and-see mentality, the next wave in eHealth is cresting. Transformational web portals will offer business process management with workflow automation, alerts, and reminders, integration with patient records, medical device uploads and a host of other equally exciting advances. Together, the unified data resources and user interaction will radically alter best-practices for patient care and healthcare efficiency.

In February 2006, a survey of healthcare CIO’s ranked the area for which they would be most likely to offer increased functionality via their web presence. Offering patients the ability to schedule appointments through their website was most frequently identified, followed by utilizing a physician portal link and providing consumer health information. However, only a handful of the CIOs report that their website is used to offer patients secure and authenticated access to medical records.

Finding themselves repeatedly on the cutting edge of eHealth, vanguard organizations are evaluating the appropriate technical platform for Level 4 applications. With Generation 4, portals started to leverage advanced Web services. This included the ability to provide Web services, as well as consume them. It also supported the first Web services standard for portlets, Web Services for Remote Portlets (WSRP), which enables one portal to consume a portlet from a different portal, using Web services protocols. Thus, portal pages could include local and remote portlets, all supporting a single set of processes.

Generation 5 is emerging (see Figure 1.) Advanced features include support for business process management (BPM), service-oriented applications (SOBAs) and orchestration, critical features to support advanced composite applications. Business Process Execution Language will become the standard orchestration language for portal products and will extend beyond the capabilities of their current workflow features.

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THE PORTAL COMMUNICATION SOLUTION

Although eHealth applications serve the needs of many different stakeholders, there are four major stakeholder groups, which illustrate the value of this solution: patients, physicians, consumers, and employees. In spite of the differences in type and format of information and services each group requires, there is significant overlap and common desire for:
o A more positive Physician/Patient experience between clinicians and patients
o A more satisfying and effective clinical experience for patients and caregivers
o A more transparent technology experience for all of the stakeholders, but particularly the caregivers and IT staff, easy to use and easy to maintain
o Better IT cost control to make the CIO and CFO’s job of keeping costs down easier
o More referrals and admits because of streamlining and efficiency improvements that expand a facility’s capacity
o Brand advancement, fulfilling the goals of the marketing department and CEO of improving community awareness and market position
o Better recruiting retention because of more effective use of staff time and skills, and easier access to human resources and other employee information
o Improved operations for administrators and clinicians, building on existing skills and significantly reducing unnecessary mundane tasks.

Each of these improvements provides additional benefits to each of the stakeholders. By empowering patients, providing rapid, real-time data access, greater efficiency, and increasing patient/ physician collaboration—everyone benefits.

However, while many vendors offer partial solutions, few offer a comprehensive portal communication solution. Legacy HIS/CIS vendors offer applications targeting information access and management, and while they improve the physician/patient experience and provide operational efficiencies, the needs of the other stakeholders are not addressed. Traditional web vendors, on the other hand, tend to focus on content management systems that excel at promoting an organization’s brand but leave the needs clinical and operations stakeholders underserved. Somewhat more comprehensive, electronic medical record (EMR) vendors offer vital elements of the big picture solution, but cannot accomplish the complete transformation that browser-based systems promise.

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FOUR AREAS REMAIN UNDERSERVED DESPITE THEIR GREAT PROMISE:

1. Consumerism - Rather than being passive participants in their own healthcare, today’s patients are looking for return on investment and driven by the spiraling cost of health insurance and growing out-of-pocket expenses.
2. Clinical - Advances in service delivery and clinical outcomes through better adherence to clinical protocols and more informed decision-making, reductions in medical errors, decreased morbidity and mortality, and expedited recovery times.
3. Financial - Cost reductions and revenue enhancements from quicker charge capture and shorter billing cycles, productivity gains from all types and levels of staff.
4. Organizational - Improvements in stakeholder satisfaction through shorter wait times, better access to reliable healthcare information, and better relationships with clinicians; higher productivity from increased procedure volume, reductions in the average length of stay, quicker transaction processing turnover, lower administrative staff and resource requirements; more effective risk mitigation, and increased adherence to federal, state, and accreditation organization standards.

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THE PORTAL PROMISE

Current, partial solutions can be made whole with interoperable portals through which all healthcare stakeholders will exchange information and engage the enterprise. Enterprise information portals are intended to consolidate a vast array of information from a multitude of sources onto a single screen. Portal technology enables different IT systems and software applications to communicate, to exchange data accurately, effectively, securely and consistently, and to use the information that has been exchanged.

A comprehensive portal communications solution should include broad-based applications through:
o Flexible, easy-to-use web content management tools for rapid application development by both non-technical staff and programmers
o Interoperability between incompatible legacy HIS systems, and real-time data access
o Secure communication allowing patients and providers to communicate conveniently
o Integrated third party applications for additional functionality

Moreover, a portal strategy should be built on a stable, secure framework, offer single sign-on, single-patient/ single-view access to all information using a coherent system of portals— simultaneously serving the needs of the wide variety of stakeholders.

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TECHNOLOGY THAT OVERCOMES ADOPTION ISSUES

Elusive Return on Investment
With billions being invested in the migration from paper to electronic records, rapid ROI is a determining factor on the minds of executives and administrators concerned about their bottom line. Speedy, enterprise-wide adoption is critical for any eHealth initiative to realize the full benefits of their investment. Delays and patchwork systems negatively impact the organizations’ ROI. Still, adoption continues to be spotty, despite incentives. In part, the gradual adoption curve can be ascribed to common complaints of HIT; accompanying workflow and systems integrations require process changes that can be intimidating. Reengineering the way work is done presents challenges that extend far beyond use of the technology. Changing the enterprise culture and convincing busy professionals to adopt and learn new systems are essential but challenging components.

A study conducted in 2001 found 121 administrators and physicians working for HCOs agreed that in order to remain competitive, providers must move toward interactive consumer web self-service capabilities (e.g. scheduling services, pre-registering for services and bill payment) and online physician patient communication. However, the reluctance to proceed was tied predominantly to a lack of funding followed by a lack of commitment, fear, politics and other intangibles that must be overcome if an organization is to be able to achieve the advanced website functionality. These findings were reiterated in the 2006 HIMSS CIO Leadership survey, which found that for the sixth consecutive year, respondents identified a lack of adequate financial support for IT as the most significant barrier to a successful implementation of IT at their organization.

Certainly, ROI is an important factor in any healthcare IT acquisition. A prudent capital investment is measured by its contribution to the sustained financial strength of the organization. However, the use of capital assets for eHealth objectives cannot be measured solely on the balance sheet. When capital investment improves clinical outcomes, reduces preventable medical errors, and eliminates common sources of waste, the return is evident in healthier patients.

Clinical System Interoperability
The fragmentation of legacy HIT systems causes interoperability issues that can undermine an organization’s confidence in their ability to successfully implement a comprehensively integrated web solution. The data systems needed for an outpatient setting require a different level of sophistication than those that regulate admissions, discharges, and transfers within in a large hospital. Each system is defined by unique vendor standards, some of them decades old. These hurdles make a seamless, rapid data sharing format seem out of reach. Integration can be tackled with the latest web technology. Using a “virtual electronic health record (EHR)” model, any HCO can connect underlying systems rapidly and cost effectively to deliver views of clinical information through secure, single sign-on, web-browser technology. The virtual EHR is dependent on a decentralized, federated data model. Using this architecture allows HCOs to leverage legacy HIS/CIS investments, avoiding the maintenance of an expensive Central Data Repository (CDR).

The federated data model eliminates system integration hassles and overcomes patient identification challenges with master patient indexing logarithms. It seamlessly integrates disparate clinical and census data, transforming fragmented data into a clean and concise dashboard of clinical information. For example, a virtual EHR presents admitting, attending, and referring physicians with ready access to all of their patients’ clinical information and, when combined with systems such as computerized physician order entry (CPOE), provides the ability to input patient order entry and review via a web browser. Additionally, online continuing medical education (CME), calendars, scheduling, clinical trial information, grand rounds, physician newsletters, and relevant clinical content may all be presented in a customizable view for each user.

Physician Acceptance
The biggest concern for busy physicians is the time and energy required to transfer data and learn a new system. They are understandably reluctant to spend time away from patient-facing activities to address administrative business. To reduce training time, leading eHealth solution providers devote considerable resources to researching and designing intuitive applications that build on existing user experiences best practices. Additionally, the federated data model eliminates the need for physicians to learn underlying applications for checking labs or reviewing films, as the view they see does not require them to interact with the software, only to view it.

Patient Identification, Privacy, and Compliance
Understandably, HCOs and physicians are sensitive to their responsibility to protect confidential patient information and may see rapid, real-time online access to vital information as a threat to privacy. Adequate security measures and an architectural design must be engineered to allow an organization to implement eHealth applications with demonstrable compliance with regulations and respect for the patients’ rights. Authentication protocols and CAPTCHA , encryption of secure messages, automatic audit trails of information access, controlled workflow and secure servers guard patient information from unauthorized access.

Cost and Training Issues
In the 2006 HIMSS CIO Survey, lack of staffing resources was identified as the second most common barrier to IT adoption. Time and resource efficiencies enabled by eHealth have been demonstrated to pay for themselves in as little as a year. Fewer chart pulls and phone calls, speedier access to accurate information, lower record maintenance, and staffing costs, and revenue enhancements together create a synergy of efficiency—more than compensating for the up-front investments. For example, reducing the need for just one administrator/trainer can save significant financial resources. One estimate based on a 40 hour work week over 50 weeks, and an average annual salary of $50,000, suggests that reducing one full time trainer can yield a savings of $61,000 USD a year. The architecture and design of eHealth products are focused on allowing non-technical users the maximum flexibility to manage their websites and portals. Additionally, intuitive design reduces the need for training and results in an immediate cost saving.


FOLLOW THE LEADERS

eHealth is no longer in its infancy, yet sustained concerns about implementing new technology is understandable. It’s a real challenge for most organizations to create a tactical plan to ensure that their web capabilities support current corporate objectives. It is far more difficult for HCOs to devise a long term plan that serves the evolving needs of the organization, adapts to technological advances, and meets new societal demands. The pressure to deliver on high-priced projects adds gravity to the matter. The initial expenses are just a small piece of the overall financial commitment an HCO makes in the transition to eHealth, and the failure rate for EHR implementations is estimated at 30 to 50 percent. False starts and implementation timeline overruns are too costly for most HCOs to risk.

To overcome these barriers, part of doing it right the first time requires research to learn from organizations that have been successful in their own eHealth initiatives. Over the past decade, a wide variety of HCOs have achieved eHealth success, from early-adopting visionaries constantly striving for better ways to engage their stakeholders, to more cautious pragmatists waiting for proven solutions to their online needs.

Some proven Canadian eHealth leaders are Hamilton Health Sciences (Case Study below,) William Osler Health Centre, and Halton Healthcare Services, Credit Valley Hospital, Scarborough General, and Scarborough Grace Hospitals. They recognize that the best way to predict the future is to create it. They did their homework and performed a thorough analysis of what is available in the market, assessed the vendors, risk, and ROI—and chose a federated horizontal portal solution to achieve enterprise-wide system interoperability while facilitating better decision making and improved communications (not to mention a virtual EHR.)

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.

"Canadian Implementation of e-Health projects increases by 39 per cent"

Initiatives benefiting patients in every province and territory.

Toronto, ON 06/25/2007: -- Canadian patients are benefiting from a 39 per cent increase in electronic health initiatives that are modernizing the way clinicians deliver health care, announced Richard Alvarez, President and CEO, Canada Health Infoway (Infoway).

"In the past year, we've seen tremendous growth in the number of electronic health record initiatives that are delivering enhanced patient care, shorter wait times and a more productive health care system for Canadians," said Alvarez, who recently released Infoway's annual report. "While this growth is encouraging, momentum must be maintained so we can capitalize on the efficiencies generated through electronic health initiatives as our population continues to age and grow."

In 2006-07, Infoway approved investments of $518.9 million in EHR initiatives across Canada, surpassing its target of $335 million. The digitization of diagnostic imaging, Drug and Laboratory Information Systems projects and the interoperable electronic health record made significant progress. With 227 projects complete or underway across Canada, Infoway and its partners are investing in modern health information systems that are uncovering efficiencies in healthcare settings across Canada. The result is better patient care and outcomes, reduced wait times and cost savings. Infoway's plan for further electronic health progress is outlined in 2015 -- Advancing Canada's next generation of health care, its long-term strategic vision document. The document is available at www.infoway-inforoute.ca.

What is EHR?

The Electronic Health Record (EHR) is a longitudinal electronic record of patient health information generated by one or more encounters in any care delivery setting. Included in this information are patient demographics, progress notes, problems, medications, vital signs, past medical history, immunizations, laboratory data and radiology reports. The EHR automates and streamlines the clinician's workflow. The EHR has the ability to generate a complete record of a clinical patient encounter, as well as supporting other care-related activities directly or indirectly via interface - including evidence-based decision support, quality management, and outcomes reporting. Other areas that fall within the EHR also include Auto ID and Bar Coding, e-Prescribing, Patient Safety and Quality/Outcomes, and Clinical Decision Support.

(More: http://www.himss.org/content/mindmaps/EHR/index.htm )

e-HEALTH 2007 - May 27th-30th - QUÉBEC CITY
The 2007 conference will be held at the Québec Convention Centre, Québec City, May 27-30, 2007.
(More at http://www.e-healthconference.com/)