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. 

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

"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/)