Differentiating between Single Sign-on (SSO), Enterprise Single Sign-on (ESSO), ESSO with Context, and Clinical Portals.

So you eventually want an EHR.
What’s the best path?
Depends on the goals.

The Evolving Landscape
Healthcare delivery organizations, departments, and stakeholders across the continuum of care use a wide variety of IT systems for storing clinical information that are rarely integrated. This disparate data can result in time-consuming and painstaking efforts to obtain a patient’s complete medical record.

Today, Healthcare organizations have a vested interest in creating an infrastructure that delivers integrated patient information. Not only is the outcome of care improved when caregivers have complete, usable data, but additional benefits are immediately acquired. These benefits include improved operational efficiency, easier compliance with regulatory requirements, a reduced need for investment in IT systems and implementation, the ability to measure and manage quality of care and participate in research, and much more.

Information systems available to healthcare organizations until now have not been able to fully to deliver these benefits. This is primarily due to IT systems lacking a common or standardized method of representing clinical data (nomenclature, terminology, coding systems, etc.). In addition, the high degree of specialization demanded by clinical practices, as well as the tendency of healthcare organizations to adopt a best of breed approach for IT systems implementation, has increased the level of diversity and disparity of data. Consequently healthcare organizations have been forced to settle for basic, limited levels or integration of their clinical applications.

Single Sign-on (SSO) and Enterprise Single Sign-on (ESSO)
Although Single Sign-On (SSO) technology dates back with some vendors to 1996, adoption has been slow. Within the past two years, interest and deployment in this technology have increased, and the solution has blossomed into more than a security solution. This technology is primarily supported by Healthcare delivery organizations to assist their IT departments in their administrative duties.

In its simplest form, Enterprise Single sign-on (ESSO) is an access management mechanism whereby a single action of user authentication and authorization can permit a user (via batch credential provisioning) to access all applications with access permission, without the need to enter multiple passwords. In the Healthcare reality, an ESSO solution by definition can reduce administrative burden, extend access to multiple applications, and increase productivity and user satisfaction.

Imagine ESSO like a Windows Desktop environment. Once logged on, users have access to any/all applications (i.e. MS Word, Excel, PowerPoint, etc.) simply by double-clicking the icon on the desktop. When the application is launched from the desktop, users naturally do not need to sign-in again. However, users still need to navigate through multiple applications, pages, and disparate data to find the clinical information they’re looking for. In a client-server environment, this is further compounded by the time required to launch the application and search for the specific patient’s clinical information. In today’s ESSO reality, to have a comprehensive view of a patient’s clinical data would effectively require launching all the associated applications and searching through disparate data individually. While the user may not need to sign-on to access the systems, it’s clear this isn’t intuitive, nor time or cost effective.

ESSO and Context Management
A conversation about SSO would not be complete without talking about context management. Some may have the impression that investing in a SSO solution means the combination of functionality afforded by both SSO and context management. Providers have expressed problems when their constituency did not understand what they were buying if they were not getting both.

Context management automatically synchronizes multiple applications in response to a single user gesture directed at any application using readily identifiable information such as a particular patient, encounter or observation. Put simply, if using multiple applications simultaneously, a Patient-search on one system can trigger a similar search in other systems. This allows for the user to access each disparate database in context. This technology is primarily supported by Healthcare delivery organizations to assist their IT departments in their administrative duties. When combined with ESSO, Context Management can extend user authentication, patient search, and allow access to multiple vendors’ native applications. More sophisticated implementations can extend context sharing at the encounter level and/or in a bidirectional manner. However, users still require the user to navigate through multiple native applications and pages to find the detailed clinical information they’re looking for. Not ideal but significantly more value than simple (E)SSO.

The premise of ESSO with Context Management implies by definition that ALL users need access to the same finite and highly detailed clinical data found in the specific department or best-of-breed system. Most would agree that the meticulous and detailed needs of those using a Lab system, for example, in the Lab environment, would be significantly different than the data needs of someone in the ER trying to access a Patients Lab results to ensure there is not a conflict. In this model, stakeholders have access to the disparate data via the native application. One of the challenges with this model is that Physicians and Clinicians have to learn and navigate through multiple (departmental or “best-of-breed”) applications to get the patient data they require.

Although steps have been made to try and optimize this delivery model, the question remains. Is this as intuitive and streamlined as it could be? Can it expand outside of a single hospital? Eventually, won’t vendors selling (E)SSO with context realize that stakeholders don’t need access to ALL the clinical information available to do their job more effectively, they need access to the clinical data that is relevant to their specific role. Each clinical stakeholder has different needs.

This author contends that the next wave of (E)SSO with context solutions will add a presentation layer to the offering such that the user is presented only with the clinical data required (versus just access to the clinical data.) However, in the context (no pun intended) of not having any access to any clinical information at the point of care, being able to access the native departmental or best-of-breed application via (E)SSO is still a quantum leap for care delivery. In the face of evolving needs and reducing resources, many opt for this path as any solution is better than no solution.

Clinical Portals
This type of solution involves the creation of a customizable user interface that can work with information from different vendors and sources. Portals are designed for the clinical end-user directly at the point of care and offer the ability to manipulate the way information is presented, in most cases regardless of the legacy vendor. They typically involve a bottom layer that is responsible for aggregation of information, and a top layer in which the information is intuitively presented to the caregiver.

For example, portals can display data any number of ways from different sources in a hierarchical structure or simple “tabbed” environment. Think of a Portal solution (results-wise anyway) as the same integration results as an (E)SSO with context solution, however served up in a customizable web-based offering where the user is presented ONLY the clinical data required (versus just access to said clinical data.)

Unlike ESSO with Context, Portals call data directly from the databases where the legacy data resides, not a duplicate of the original transaction on a repository. This ensures data is queried in real-time, eliminates the need for a centralized data repository (CDR) and associated brokers and can also provide advantages in areas such as flexibility, scalability, availability, and even security to a limited extent, because information remains where it is created and each organization is free to administer its resources as it sees fit.

Moreover, Portals by definition offer unfettered use of the information. Because information is only handled in the presentation tier, the type and depth of data manipulation, cross-reference and analysis are unlimited and can be customized by user. This is primarily because, even though Portals are easy for Hospital IT departments to maintain, administer, and manage---they were originally designed to meet the clinical stakeholder’s unique needs.

One of the strongest differentiators for Portals is the fact that Clinicians and Physicians don’t have to learn multiple (departmental or “best-of-breed”) applications to get the clinical data they require. Users only need their respective departmental solution, and a portal to aggregate all other relevant data. Today’s Portals can accomplish everything a (E)SSO with context can all on a future-ready, scalable, standards-based platform. Although (seemingly) diametrically opposed paths, both ESSO with context and Portal paths can by definition provide a comprehensive, transferrable EHR. The differences are in time to implement and cost.

Future Proof
The realistic and “future proof” way to achieve an actual, real-time picture of a patient’s medical history is with a solution that provides interoperability – creating a unified patient record from the various sources holding patient data, no matter where they are located, or in which format. Any solution implemented must also accomplish this while adhering to privacy and security policies as well as auditing requirements of the organization/s and relevant regulating authorities. Moreover, the solution must be able to resolve issues of identity (name with/without middle initial, married/maiden names, etc.--aka MPI) and to deal with situations in which one patient may have more than one registered identity within and across multiple information systems.

So whether starting from fresh, or currently on a (E)SSO-with-context path and looking for a presentation layer (or EHR/EMR Viewer,) clinical stakeholders need intuitive, customized and streamlined access to relevant patient data. The true benefits of interoperability will only be realized when the integrated patient information is used not only by means of having it presented to the caregiver via a portal of some sort but rather by leveraging the data as a key clinical asset and using it to meet the needs of quality, compliance and management initiatives. The challenges that most organizations deal with in their quest to execute these initiatives mainly revolve around dealing with the lack of access to the broad set of medical data required for successful implementation. A robust interoperability solution holds the key to unlocking this information and turning such initiatives into a reality.

While any given EHR solution theoretically may be achieved via multiple paths, the ultimate vision is to create a single, unified patient record based on data from different information systems, formats, sites and if needed even across organizations, enabling the data to be integrated, analyzed and used – without affecting the systems in which information is stored.

Clinical Portal Vendor MEDSEEK leads in 2008 KLAS® Rankings

MEDSEEK Leads KLAS® Portals Segment as of August 22, 2008.

Birmingham, AL (PRWEB) September 4, 2008 -- MEDSEEK, a leading provider of enterprise portal management solutions, announced today it leads in KLAS® rankings for its Clinical Web Portal software solution.

KLAS® is an independent healthcare market research firm that gathers data about clinical portal solutions from CIO's, Directors, and other healthcare providers about software functionality, solution performance, technical support and service. According to the August 26, 2008 Platinum KLAS ® database, MEDSEEK has the highest current performance ratings, outscoring all other clinical portal solutions.

Peter Kuhn, President of MEDSEEK commented, "MEDSEEK's superior ranking in the KLAS ® report highlights our effort to provide comprehensive eHealth solutions." Kuhn added, "We frequently receive high praise from our clients on our ability to deliver complex installations on time and on budget. The KLAS rating validates our reputation as an organization that consistently delivers on our commitments."

The KLAS® database also reports anonymous comments from providers who are using the eConnect Clinical Portal solution: "The implementation process was very smooth. It was very well planned and organized and was executed according to that plan. The planning was very thorough and there were few surprises and gotchas along the way. The implementation staff MEDSEEK provided was very knowledgeable. They were excellent communicators. We were able to install the system on time and within budget.” (Quoted from a healthcare provider interviewed by KLAS, see KLAS® commentary August 26, 2008.)

"MEDSEEK eConnect is the perfect portal solution for our physicians who do not want to learn the complexities of using the PACS and hospital clinical systems. This product is a single sign-on system that helps doctors get to patient information quickly. We have heard nothing negative from the physicians. All of the feedback about using eConnect for pulling results has been good, and the doctors love being able to pull images by using a URL." (From the KLAS ® database, August 26, 2008.)

Michelle Wickham, Research Director for KLAS stated, "KLAS applauds those vendors who utilize KLAS® data to understand and respond to their customers' needs. We are pleased when the data shows that a vendor is performing well, and we plan gather data on an ongoing basis to continuously monitor vendor performance in this segment."

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About MEDSEEK:
Birmingham, Ala.-based MEDSEEK provides healthcare organizations with Enterprise eHealth solutions to fully engage and strengthen relationships with key constituents - physicians, patients, employees, and consumers. By connecting information and communities to foster an enhanced experience with the organization, hospitals will improve community advocacy, revenue and patient acquisition/retention, physician relations, and clinical decision making.

MEDSEEK's comprehensive technology platform and strategic consulting services create the infrastructure and provide the thought leadership for hospitals to deliver the most powerful Portal solutions. With more than ten years' experience and 600+ hospital customers, MEDSEEK has the experience and expertise to meet the diverse needs of the healthcare community. MEDSEEK also maintains offices in California and Mississippi. In Canada, Medseek is distributed by Agfa HealthCare. For more information, visit MEDSEEK or call 888-MEDSEEK.

About KLAS:
KLAS is a research firm specializing in monitoring and reporting the performance of healthcare vendors. KLAS' mission is to improve delivery, by independently measuring vendor performance for the benefit of our healthcare provider partners, consultants, investors, and vendors. Working together with executives from over 4500 hospitals and over 2500 clinics, KLAS delivers timely reports, trends, and statistics, which provide a solid overview of vendor performance in the industry. KLAS measures performance of software, professional services, and medical equipment vendors. For more information, go to www.KLASresearch.com, email marketing@KLASresearch.com, or call 1-800-920-4109 to speak with a KLAS representative. The data referenced was retrieved Tuesday, August 26, 2008 and fluctuates daily. Copyright 2002-2008 KLAS Enterprises, LLC. All rights reserved.

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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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Healthcare 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 serving as 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.

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 today's healthcare delivery (and public health at large) is information. The use of 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 alone 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 recent Advertising campaign by Rexall Drugs in Canada identifies that as many as 200,000 Canadians are hospitalized annually from negative interactions with medications. Moreover, 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.”

So, whether the goal is to heighten prevention, detection, integration, or extend patients self-management---our healthcare delivery paradigm is clearly shifting to focus on connecting individuals rather than infrastructure---effectively putting patients (and clinicians) at the centre of new models of connectivity for improved communication and collaboration.

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

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

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

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

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

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

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

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

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

The Emergence of the Patient Portal

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

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

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

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

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

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

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

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

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

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

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

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

Google Health opens, sparks privacy woes

After a year and half of development, Google's online filing cabinet for personal medical records is open to the public, giving users instant electronic access to their health histories, while reigniting privacy concerns.

Called Google Health, the service lets users link information from a handful of pharmacies and care providers, with plans to add many more. The Internet search giant is the latest entrant in the growing field of companies offering personal health records on the Web. Their ranks range from longtime online health services such as WebMD to the software powerhouse Microsoft to start-ups such as Revolution Health.

The companies all hope to capitalize on the trend of consumers increasingly seeking health information online, and the potential of Internet tools to help them manage their own health care and medical spending.

Google enters the field of personal health records with a leading online brand, deep pockets and a wealth of technical skills. In a two-month trial this year, the Cleveland Clinic found that its patients were eager to use the Google health records. Google Health differentiates itself from the pack through its user interface and features such as the public availability of its application program interface, or API, said Marissa Mayer, the Google executive overseeing the service.

More than two dozen companies and institutions announced that they are partners with Google Health, including Walgreens, CVS, the American Heart Association, Quest Diagnostics, Beth Israel Deaconess Medical Center and the Cleveland Clinic.

Mary Adams, 45, a Cleveland Clinic patient who participated in the Google Health pilot, said that she was initially concerned about the privacy of her medical information. Still, she felt safe enough to enroll and has been using the service for six months, linking it with an online health management tool from the Cleveland Clinic and adding information on prescriptions and doctors to her online profile.

The service, still a non-final ''beta'' version, does not include ads. Besides importing records from providers, users can enhance their password-protected profiles with details such as allergies and medications, they can search for doctors and they can locate Web-based health-related tools. The health venture provides fodder for privacy watchdogs who believe Google already has access to too much about the interests and habits of its users in its logs of search requests and its vaults of e-mail archives.

Pam Dixon, executive director of the World Privacy Forum, said services such as Google Health are troublesome because they aren't covered by the Health Insurance Portability and Accountability Act, or HIPAA. Passed in 1996, HIPAA set strict standards for the security of medical records.

By transferring records to an external service, patients could unwittingly make it easier for the government, a legal adversary or a marketing concern to obtain private information, Dixon said. During a webcast earlier this week, Mayer said users' health information is stored at Google's ''highest level of security.'' Mayer said in an interview with The Associated Press that users' health information will not show up in search results.

Utah company is participating: A Utah company is one of 14 businesses and organizations that are part of the offerings of Google Health. MediConnect Global of South Jordan offers to retrieve medical records for Google Health users and to identify information from them to be placed in their profiles.

MediConnect will digitize the records from health care providers identified by customers. Customers will be able to access their records online or download them to their own computers. "MediConnect's medical record retrieval service allows people to have access to information from their personal health history from anywhere in the world at anytime," said Amy Rees Anderson, company CEO. The company charges a fee of $98 for up to 100 pages and 10 cents per page for additional records, said Cory Maloy, director of communications. The company complies with the federal health privacy law, he said.



View Original article.

Online Health Info System Is Unveiled by Microsoft: Privacy and Security top list of concerns.

Microsoft Corporation has released a new software product and free Web-based platform that allows individuals to collect, store, and share their electronic medical records. HealthVault is intended to allow people to access their medical records through any device, regardless of the health care provider or insurer. Microsoft has also developed HealthVault Search, a new Internet search engine that helps people find answers to health questions, learn more about topics important to them, confidentially store information they discover, and act on that knowledge to improve their health and wellness.
HealthVault Search also intuitively organizes relevant online health content, allowing people to refine Internet searches to more efficiently find information.

Empowers Consumers
Experts say technology can play a key role in helping solve the problem of "health care fragmentation," the dividing up of a single patient's providers and records between several organizations and locations, and can empower consumers by giving them more control over, and information about, their health care.

"A system like HealthVault can help put patients in control of their own health care by putting information and access directly in their hands, instead of forcing them to go through various intermediaries," said Jeff Emanuel, research fellow for health care policy at The Heartland Institute and managing editor of Health Care News.

"A functional market must be based on empowerment of the consumer, and the health care market is no different," Emanuel said. "Telemedicine and health care technology allow consumers to control their own treatment and records, thereby giving them a stronger hand in their care."

Security Measures
While developing HealthVault, Microsoft consulted privacy advocates, such as the Coalition for Patient Privacy, along with online security experts. HealthVault keeps a log of each time a record is written, changed, or read, which means users can view an audit trail in their personal HealthVault account at any time. Microsoft's HealthVault systems and databases are safeguarded with extra precautions, such as isolating data center traffic on a virtually separate network, and keeping servers in physically separate, locked cabinets. All data traffic to and from HealthVault and its solution providers is encrypted. The system's backup data are also encrypted, and its transportation is logged every time a record is accessed, uploaded, or downloaded.

Privacy Concerns
Not everybody feels confident about Microsoft's ability--or intent--to protect patient privacy. Some analysts point to the system's privacy policy as a sign it is still vulnerable to the targeted disclosure of private information. The policy says, in part:"Microsoft may access and/or disclose your personal information if we believe such action is necessary to: (a) comply with the law or legal process served on Microsoft; (b) protect and defend the rights or property of Microsoft (including the enforcement of our agreements); or (c) act in urgent circumstances to protect the personal safety and welfare of users of Microsoft services or members of the public" (emphasis added).
"Privacy concerns are consistently shown to be one of the public's biggest worries as health care moves toward a digital future," said Emanuel. "Microsoft's reservation of the right to disclose personal medical information if company officers see such a disclosure as being in the company's best interest is worrisome.

"Security of information should be a primary focus in technological endeavors such as these," Emanuel continued. "Despite the best of intentions, lapses in security can occur, and information can be inadvertently released. Purposely disclosing personal health information is far worse than that.
"Regardless of the reasons for disclosure, the results of such a violation of privacy can be devastating," Emanuel said.

Published In: Health Care News | June 1, 2008 | The Heartland Institute

Microsoft launched the beta version of HealthVault in October 2007. The site was officially launched this February, and in April it was opened up for wider use. Click here to learn how Microsoft® HealthVault™ helps Physicians and hospitals better connect with patients.

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

The Brampton Guardian | Monday December 24 2007 | PETER CRISCIONE

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

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

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

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

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

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

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

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[Original Article]

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

[Original article]

A Closer View of E-health

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

eHealth Leaders | Mississauga Hospitals sharing patient records

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Hamilton Health connecting around the world

Hamilton Health Sciences' orthopedic surgeon Dr. Justin deBeer was halfway around the world in Taipei, Taiwan but wanted to be able to keep tabs on his patients back in Canada. What in the past would have been a next to impossible proposition was actually done quickly and easily thanks to ClinicalConnect – a web-based portal for physicians that brings together data from three of the hospital’s most commonly used clinical software systems in an electronic health record format.

Hamilton Health Sciences worked with Medseek to design and implement the "ClinicalConnect" portal, but also engaged physicians from a variety of disciplines to offer input and drive the creation of the final product. Since Meditech is the most widely used information system at Hamilton Health Sciences, it was the first to be merged into the ClinicalConnect environment. ClinicalConnect offers a user-friendly view of the Meditech information, which ranges from admission information to lab results, and allows physicians to view the information simply by signing on to ClinicalConnect.

The next step involved adding views of patient records, stored in a system called Sovera. Currently the charts are scanned and merely displayed through ClinicalConnect, however, the portal does allow physicians to view the information and also indicates the number of chart deficiencies that need to be resolved. By the end of this year, physicians will be able to access Sovera directly through ClinicalConnect, which will enable them to interact with patient information in real time and directly resolve any chart deficiencies. In the future, physicians will have the option to e-edit and e-sign Meditech-based charts in the portal, and the updates will be passed back to the Meditech system. When this feature is available in the portal, it will also be available via PDAs.

Adding PACS to the system proved to be a tremendous enhancement, since it enables physicians to view X-rays from the same system that houses other clinical information about their patients. And by signing on to one system, physicians can access and interact with all of this information. They can also customize their views and pick and choose which information they want to see and when.

“Our ClinicalConnect portal gives physicians and other clinicians secure, real-time access to electronic patient records. Whether they are at the hospital or elsewhere, our physicians can quickly access all clinical reports, lab results, PACS images, pharmacy medication lists and much more,” said Dale Anderson, information and communications technology manager of projects and e-Health solutions at Hamilton Health Sciences.

As Hamilton Health Sciences expands the wireless network within its four sites, ClinicalConnect will become even more valuable. Already, some physicians have been piloting wireless applications of the system on PDAs in certain areas of the hospital. They’ve got access to all available patient information when they are seeing the patient. Patients are also able to ask questions about particular tests and procedures when they are with their doctor and do not have to wait for results to be retrieved from another computer or system.

The remote access to patient information through ClinicalConnect enables healthcare providers him to use remote Internet access to call up the patient’s information, including X-ray images and blood work, to check up on patients.

View a (Flash-based) overview of Hamilton Health Sciences "ClinicConnect” solution.

Originally published in Canadian Healthcare Technology, April 2007

100% Paperless Healthcare and the EHR

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

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

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

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

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

All eHealth Portals Are Not Created Equal

All levels of government across Canada are experiencing similar pressures today to cut healthcare delivery costs while increasing patient safety and care. With this growth in managed care and capitation, eHealth Portals are quickly evolving to meet new and more complex requirements, with significant benefits to medicine and healthcare in general.

As the practice of medicine is inherently dependent upon healthcare technology, the sustainability of our healthcare system depends, to an extent, on its ability to find ways to gain efficiencies and effectiveness in every aspect of our daily activity. Canadian Healthcare providers need to find ways to work smarter, not harder.

Building the future is really about building the present.
Marshall McLuhan once observed that too often people steer their way into the future while staring into the rear-view mirror---because the past is so much more comforting than the present. The problem with history however, is that our love of certainty and continuity often causes us to draw the wrong conclusions. To this end, in the past, the acquisition of technology had been viewed as an end in and of itself. Decisions about technology and usage were typically driven by the question of how to improve the effectiveness of what hospitals were already doing. Today’s information systems should be viewed as a vehicle to transform what Hospitals actually do. Moreover, there is a demonstrated understanding of the need to evolve healthcare informatics toward a more open, standards-based, patient-centric model that brings together all imperatives: clinical, administrative, financial, managerial, and human resources---in a meaningful way that concentrates on patient outcomes as the primary goal of the organization (and the method by which other parameters, such as financial efficiency, are to be judged.)

Lessons from False Starts
Whether an early-adopting visionary or a more cautious pragmatist, with the myriad of messaging from analysts, researchers, and pundits—concerns about implementing seemingly new or nascent eHealth Portal technologies is understandable. The sheer volume of new technologies coming to market only adds to the confusion and it’s a real challenge for most healthcare organizations to create a tactical plan to ensure that their IT capabilities support current and future objectives. To overcome these barriers and eliminate false starts, part of doing it right the first time requires an understanding of a.) the clear differences in the eHealth Portal solutions available in our Canadian market and b.) the new (transinstitutional model) horizontal architectures.

"Federated" and "Centralized" database models REDUX
When a healthcare organization sets out to extend a longitudinal ‘cradle-to-the-grave’ patient record (readily accessible via the Internet) linked to clinical protocols and guidelines—most people picture only one scenario. In this scenario, a user enters a query about a patient. That query goes to one source where all the patient information has been stored in a single “centralized” database (or vertical architecture.) The system searches that one database and returns the answer to the user. But information does not have to be accessed in this manner, as the patient data already resides somewhere in existing systems. Instead of duplicating that data in a new centralized system, the healthcare organization could leave the existing data in place. Then, when the user asks a question, the system gathers the appropriate patient data from wherever it is stored. This approach — leaving the data in place and retrieving it on demand — is called a “federated” database model (or horizontal architecture.) By definition, a federated database is a collection of data stored on multiple autonomous computing systems connected by a network that is intuitively presented to users as one integrated database.

Years ago, the centralized approach represented the more attainable of two limited choices — even though a massive initial investment of time and money was required (to build, load, and integrate a centralized database coupled with the painful patchwork of disparate legacy systems, brokers, and related integration and maintenance problems.) A good example of this is Trillium Health Centre’s $100 million dollar, seven year initiative to integrate all patient information into a single record. However, advances in technology and new product capabilities have made the federated approach a far more practical and significantly more cost-efficient option. Compared to a centralized eHealth Portal built on a single “centralized” database (or vertical architecture,) a “federated” database (or horizontal architecture) can achieve equivalent or better results at a fraction of the cost and time. Given our Canadian healthcare funding reality — this is an option that more and more healthcare organizations are likely to choose.

The real value: A fraction of the cost and time.
Anyone who uses the Internet takes the delivery of content from multiple systems for granted. Almost every Web page on a major commercial site is assembled automatically from multiple sources. Click a button and data is retrieved from other databases and servers. Users may not be aware of this, but it goes on constantly. Federated databases operate by means of a similar principle, except that each data resource is defined by means of a database schema or view, and the user has much more power to access and manipulate the data. With the federated Portal approach, the economics are significantly different and can be extremely advantageous. You don't buy the massive database server (or related brokers) and you leave all your data where it is. You don't need to build systems to update the database, as the integrated database is virtual. It exists only in the form of the views presented to the users. When a user submits a request for data, the federated database system performs extraction, cleansing and transformation, and the equivalent of loading for only that data needed to satisfy the user's request.

One of the greatest advantages of a distributed (federated) architecture is that it naturally lends itself to supporting a large variety of connected systems and guarantees the scalability of the portal system at the enterprise level. Moreover, a federated portal approach allows bandwidth, hardware, administration, and other infrastructure costs to be distributed over time, keeping pace with the development and deployment of the facility. This can significantly reduce networking and system-interfacing costs and opens up a number of added functional possibilities by extending data to the organization’s value chain delivering clear, tangible benefits for your short and long term needs.

Follow the leaders
The use of eHealth Portals has gained significant traction as a cost-effective way to transform healthcare delivery. Whether physician, nurse, technician, or administrator, eHealth Portals offer a proven, quick and efficient way of accessing, sharing and organizing hospital information and patient records. Portals also extend process-integrated decision support and a clear stepping stone to a national electronic health record. However, what has become clear, is that all portals are not created equal. As a result, identifying the right portal approach and architectural model, is critical for healthcare delivery organizations to maximize tax dollars and return on investment.

Examples of Canadian Hospitals who have successfully implemented an eHealth Portal initiative (whether Physician, Patient, or other) using a “federated” database model (or horizontal architecture) are Hamilton Health Sciences “ClinicConnect” initiative and Mississauga Halton's (LHIN 6) "REACH" initiative. An overview of the “ClinicConnect”solution is available at: http://www.hamiltonhealthsciences.ca/quicktour.htm