Global Perspective: China’s “Green Book” and Personal Health Record’s

PHR: Is There an Easier Way? The Chinese “Green Book” achieves some goals currently unattained in the U.S.

Perhaps this will be the year Personal Health Records (PHRs) will catch on with the public and begin realizing their potential. There is certainly no shortage of products available. Nor is there a shortage of approaches to the technology, level/type of information stored and sophistication of tools. Surveys indicate PHR's are gaining the interest of the American health care consumer and suggest that large-scale usage cannot be too far off. Nonetheless, the PHR still has the lowest adoption rate of any major EHR function in hospitals and physician offices.

Are we over-complicating the concept of the PHR? After all, patients have always been the primary source of information about their personal illnesses and injuries, but now that we are starting to utilize technology, create laws, and develop policies and procedures about such information, we may actually be creating problems. Perhaps we could learn a lesson from China — where a simple, yet remarkably effective (in some ways,) version of the PHR is in widespread use.

The Green Book
Patients visiting many of China's public hospitals for outpatient care receive a "green book" that constitutes their ambulatory patient record. During the course of a patient visit, the doctor enters clinical notes such as patient complaint, test results, diagnosis and prescribed medications. All notes are handwritten.

At the conclusion of the visit, the physician gives the 'Green Book' back to the patient or other responsible party. When the patient returns for treatment or medication refill, he/she must bring the 'green book', which the physician uses to maintain continuity of care. Neither the hospital nor the physician keeps a copy of these ambulatory records; the patient receives the sole copy.

A number of concerns seemingly make this approach unworkable in the U.S., such as the risk of losing the record, the potential for unauthorized changes to it, legibility issues and the need for a legal business record. But despite its shortcomings, the 'Green Book' achieves some goals currently unattained in the U.S.:

Portability: So long as the patient brings their 'Green Book' to the visit, it can be shared with any provider without hassle or delay.

Interoperability: Could U.S. interoperability issues really be a euphemism for "I don't want to do it?" Are we making it too hard by trying to be perfect?

Patient Accountability: The responsibility for preserving, protecting and presenting the record belongs to the patient. The U.S. is not advocating that the health care system place such responsibility and accountability entirely on the patient, but maybe sharing would be beneficial?

General Standards: The standards for use, format and content are high-level, achievable and appear to be well-accepted.

Physician Acceptance: It appears that virtually all caregivers who are supposed to use the green book actually accept it. The temptation for individuals to replace it with something they like better appears to have been resisted.

The Chinese are not drowning in worthy options. The green book PHR concept is simple, especially in comparison to American high-tech options. However, sometimes our technology becomes as much a barrier as a solution and large-scale PHR adoption will not occur in the U.S. until the outlined goals are achieved using technology as an enabler.

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Original Article by Michael R. Cohen, CPHIT, CPEHR, FHIMSS, and Margret Amatayakul, RHIA, CHPS, FHIMSS.

Health Care in Canada Report (HCIC 2008)

Health Care in Canada 2008 (HCIC 2008) is the ninth in a series of annual reports on Canada's health care system by the Canadian Institute for Health Information (CIHI.)

The Health Care in Canada (HCIC 2008) Report provides a review of key analytic work undertaken at CIHI that highlights CIHI's health care research priorities (access, quality of care, health human resources, funding/costs, etc.). Also included in this report is a review of seminal national and international health care research as it maps onto these health care priorities. HCIC 2008 is a tool for health care researchers, persons involved in strategic decision-making in health care, the media and Canadians in general to identify current priorities in health care.

DOWNLOAD HCIC 2008 REPORT (.PDF).

About CIHI
The Canadian Institute for Health Information (CIHI) collects and analyzes information on health and health care in Canada and makes it publicly available. Canada’s federal, provincial and territorial governments created CIHI as a not-for-profit, independent organization dedicated to forging a common approach to Canadian health information. CIHI’s goal: to provide timely, accurate and comparable information. CIHI’s data and reports inform health policies, support the effective delivery of health services and raise awareness among Canadians of the factors that contribute to good health.

KLAS announces top-performing Healthcare IT software and services vendors for 2008

The 2008 Top 20 Best in KLAS Awards lists top Healthcare IT vendors in a number of software categories (view Top 20,) as well as several professional services categories.

KLAS Founder and Chairman Kent Gale said more than 1,500 interviews were conducted. Gale added that KLAS is developing new categories and refining others based on the comments received during the interview process. The company has added cardiology as a category, he pointed out, while it is working on designations for RFID assets and labor and delivery and others.

As the Clinical Portal category is relatively new, KLAS does not yet extend a “Best in KLAS” rating, however MEDSEEK is the Category Leader for Clinical Portals in the recent report. (View Report)

"Since 1998, the Top 20 Best in KLAS Awards report has been shining a light on the performance of vendors throughout the healthcare industry," said KLAS President Adam Gale in a press release. "Today the objective of the report remains the same: To help healthcare providers make informed decisions, whether they're looking to buy technology, review a current vendor, validate an operational decision or determine the right products to remain after a merger."

View Original Article

Top 50 Health 2.0 Blogs

It’s clear the Internet is transforming how we practice medicine, biomedical research, and empowering health care stakeholders. While we have seen many new concepts and terms appear and disappear, the term “Web 2.0” is increasingly being discussed.

Recent advances in web technologies and user interfaces has greatly changed the design and pervasiveness of Web applications, and in many cases actually transformed the way users interact with them. As eloquently argued by Mandl and colleagues in the New England Journal of Medicine, these developments represent “tectonic shifts in the health information economy” with far-reaching consequences for patient involvement, as the gravity shifts away from health care providers as the sole custodian of medical data.

Health 2.0 embraces the idea of bringing health care into the community of physicians, patients, and those in the health care industry together with technology and the Internet to provide the best possible health care environment.

What better way for the various parts of this community to share their thoughts and communicate ideas than through their blogs? From corporate blogs to blogs that are a part of social networks to individual blogs touching on technology or health care policy, these blogs will help bring you into the community, provide information and resources, and may perhaps help you find your voice as well.

2.0 CORPORATE BLOGS
From popular medical websites such as WebMD and Healthline to Health 2.0 sites like Organized Wisdom, these blogs bring you health information on a variety of topics.

1. WebMD Community Blogs. This trusted source of medical advice offers blogs ranging from ADHD to men's health to urology. Select one or more topics to learn the latest in that field.

2. Mayo Clinic Blogs and Podcasts. Stay on top of subjects such as pregnancy, stopping smoking, nutrition and more with the blogs and podcasts available at this site.

3. Healthline Health Matters . Read the blogs available through Healthline here. Topics include cancer treatment, reproduction, teen health, nutrition, and much more.

4. MedlinePlus Health News. Click through the daily news updates on this government-sponsored site or sign up for the RSS feeds to have the news delivered straight to you.

5. ENURGI. This company works to connect families, patients, and health care givers. The blog provides updates about the company as well as helpful advice on topics such as checking references for caregivers and exercise and health.

6. The Revolution Manifesto. RevolutionHealth offers a community resource to find information about health and wellness, illness, and connecting with others. Their blog highlights important health care issues and how those issues affect changes within the company.

7. HealthNex. From IBM employees concerned with health care innovations that help the global community, this blog brings topics such as e-records, health policy, and technology to Health 2.0 readers.

8. The Health Wisdom Blog. From Organized Wisdom, the site that gives you information on your health with WisdomCards, be sure to follow this blog for updates on the latest 2.0 tools.

9. NeoTool Healthcare IT Blog. From NeoTool, a hospital systems integration software, this blog offers the latest IT trends with a focus on hospitals in particular as well as information about the NeoTool software as well.

10. SharpBrains Blog. This blog keeps you updated on the latest brain health news and research. Don't miss their Medicine 2.0 blog carnival where they offer the best of the blogs offering 2.0 information.


SOCIAL NETWORKING BLOGS
Medical social networking sites offer lots of information on their blogs, usually with the angle of reader-based research. Check out these blogs written by highly informed patients and medical professionals alike.

11. The Value of Openness. From PatientsLikeMe, this blog brings the best of patient-led research to you. Recent posts have touched on young-onset Parkinson's, MS, and genetics discrimination.

12. Doctor Blogs at Daily Strength. From Daily Strength, these physicians share their knowledge on topics ranging from why men don't seek health care treatment to high school sports to the five stages of grief.

13. PeoplesMD Blog. Get the latest on both social networking and health issues--especially as they have to do with one another--on this blog from PeoplesMD.

14. Trusera Blog. Trusera is a social network of patients who are sharing their health experiences. The blog brings you updates in the world of health care as well as updates on Trusera itself.

15. change: healthcare. This social networking site allows patients to compare and support each other on health care topics such as illness, prescription drugs, and many other health care topics. The blog keeps you updated on health care news such as how to spot an online medical scam or whether or not you should get married for health care benefits.

16. HealthCareVox. Not actually a part of any one social networking site, this blog focuses specifically on how social networking plays into the world of health care and technology. Recent topics have included the success of specific online communities and a global study on social technology.

17. PsychCentral Blogs. PsychCentral, an online psychology community, offers this blog to keep you updated on the latest in the field of psychology such as face recognition and the relationship to social culture and non-drug approaches to treating ADHD.

18. The SoberCircle Guy's Blog. The official blog of SoberCircle, you can find posts about both social networking and the 2.0 technology used to create a supportive and healthy environment.

19. New Media Medicine Blogs. Read the blogs from physicians, med students, and pre-med students from this social networking sites for doctors. Sponsored by a university in New Zealand, these blogs definitely have a distinctive feel separate from similar U.S. blogs.

GENERAL HEALTHCARE AND WEB 2.0
From the latest in health 2.0 tools to a listing of current medical blogs, these 2.0 blogs will keep you current and in the know.

20. Health 2.0 Blog. A blog written by leaders in the health 2.0 movement, these posts will keep you abreast of all the latest trends and technologies occurring in the health care world.

21. The Health Care Blog. A sister site to health 2.0 Blog, this blog expands coverage in its posts to include not only the 2.0 aspect, but also the latest news and inside happenings in the health care industry.

22. The Doctor Weighs In. Five physicians post on this health care blog that frequently features plenty of health 2.0 topics such as the future of health 2.0 tools.

23. Diabetes Mine. This comprehensive site detailing all aspects of managing diabetes offers a blog with a strong focus on the 2.0 aspects of online technology and community connection.

24. Medical 2.0. Written by a pediatrician and health 2.0 guru, this blog offers great tips and resources for enhancing your health and medical 2.0 library.

25. Frankie Speaking Frankly. This blogger from the U.K. brings you interesting posts about the world of health and medical 2.0. As the creator of MedWorm with a strong interest in medical research, her experience in the field is sure to provide great insight to the current and future trends of health 2.0.

26. Web 2.0 and Medicine. Find reviews and updates on the latest web 2.0 tools that affect the field of medicine on this blog written by a physician with a strong interest in the progress of health 2.0.

27. Medgadget. This hugely popular blog provides the latest in medical technology both on and off the Internet.

28. Clinical Cases and Images--Blog. This blog brings the world of medicine together through their informative and interesting blog. Get the latest news, interesting blogs, and newest technologies here.

29. ScienceRoll. This medical student with a strong interest in web 2.0 technology writes about the intersection of these two fields in his blog.

30. Informaticopia. Blogging about the world of eHealth around the world, this blogger is based in the U.K., but also touches on health 2.0 in Canada and the U.S. as well.

31. Medlogs. For a listing of medical blogs, this news aggregator brings the latest medical blogs to you in one spot. Read through the most current blog list or browse through the categories of blogs on the left-hand menu.


HEALTH AND TECHNOLOGY BLOGS
Health 2.0 is inextricably linked to technology, so read about how technology and health care affect each other in these blogs.

32. Health Populi. Written by a health economist, this blog looks at how health care and technology intersect. Recent posts include health care debt trends and the economic impact on health insurance, medical treatment, and prescription drug use.

33. iHealthBeat. Actually more of a journal than a blog, this site offers updates on Monday through Friday on how technology affects the health care industry. A part of the California HealthCare Foundation, some of the news is a bit more geared to California and the west coast.

34. HIStalk. This Health IT blog serves primarily as a news aggregator for all the HIS inside industry scoops, but it also provides reader-written posts about the industry.

35. The Healthcare IT Guy. Written by a CEO of a health care IT company, this blog offers plenty of reviews for great health 2.0 sites as well as updates about health care as it pertains to technology.

36. eHealth. Blogging on the nuances of eHealth, health 2.0, and medicine 2.0, this writer discusses the various aspects of technology and health care systems.

37. Neil Versel's Healthcare IT Blog. Read about podcasting, blogging, open source, privacy and more as these aspects of technology pertain to the health care industry.

38. Future of Health IT. This news aggregator blog lets you know the latest news on IT trends and happenings as they relate to the health care industry.

39. The Healthcare Information Systems Blog. While currently undergoing a re-focusing of direction, this blog generally examines health care and its association with technology innovation.

40. Efficient MD.com. This site offers the latest on technology, best practices, and lifehacks. Stay on top of what technology your physician has available in her field.

41. Kidney Notes. Not necessarily just focusing on kidneys, this blog offers a good mix of medical technology news, funny journal articles, and other random fun-ness. Medical professionals and laypeople alike will enjoy reading this blog.

42. davidrothman.net. Combining medical librarianship and Internet technology, this blog offers great 2.0 tools and tips for those in the health care industry.

43. Laika's MedLibLog. Another blog heavy on the medical library end of health 2.0 and written by a Dutch medical information specialist, this blog offers topics such as WikiMindMap, Dutch medical blogs, and more.


HEALTHCARE POLICY AND LAW BLOGS
The current state of health care in America just begs for health 2.0 intervention with communities and technology working to make a change for the better. These blogs let you know how the struggle to improve the system is going.

44. Kathleen's Blog: Second Opinion. A part of CodeBlueNow!, the founder writes this blog with inspirational and thought-provoking calls to arms for those working to make a change in health care policies.

45. Crossover Health. This blog is a great example of the Renaissance nature of health 2.0 as it strives to find a way to make policy changes through inclusion of physicians, patients, and policy makers as they incorporate aspects of technology and finance to improve health care for all.

46. Health Care For All. This non-profit works to create a better health care system through creating a consumer-centered system, and their blog provides the latest developments in their pursuit of better quality care.

47. A Scanner Brightly. This blogger is going about making changes in policy by bringing more medical transparency to the field. As a supporter of this movement, you will find topics comparing U.S. healthcare to other countries and examinations of current transparency policies.

48. Amateur Economists. While not strictly a health blog, the economic topics here frequently touch on health care policy and how economics affects changes. This blog is geared towards those who are not well-versed in economics, but want to understand the implications on current events.

49. Health Care Law Blog. This lawyer blogs about the intersection of health care, the law, and technology. Topics frequently touch on electronic health care records, social networks as they pertain to health care, privacy, and more.

50. HealthBlawg. Lawyer David Harlow writes about health care, technology, the law, and health care policy on his blog.

Published on RNCentral.com Wednesday September 17th , 2008 | Read original article

Global Perspective: NHS Scotland’s e-Health Strategy

The potential of information technology to support improved healthcare is recognized across the world. There are many approaches to delivering this potential; Scotland is building an approach that best fits the needs of NHS Scotland.

In Scotland, the e-Health Strategy is setting a course which focuses on improved healthcare more than technology. It also seeks to build on the significant progress we have already made to move to progressively stronger and more integrated support for the provision of care. The e-Health Strategy targets the key priorities set for health while also looking to build the wider vision of more integrated care and the use of information to promote better, more efficient and safer care for patients.

Read NHS SCOTLAND’s eHealth Strategy.

4th Annual Canadian Health Informatics Awards

The 4th Annual Canadian Health Informatics Awards Gala, held on November 19, 2008 at the Sheraton Centre in Toronto, celebrated the outstanding achievements and excellence in the Canadian Health Informatics Community. ITAC Health (formerly CHITTA, Health Division of ITAC) and COACH: Canada’s Health Informatics Association co-hosted the gala.

Congratulations to:


The Gala celebrated the following outstanding achievements:

2008 COMPANY OF THE YEAR
Winner: Telus Health Solutions

2008 HEALTHCARE TRANSFORMATION
Winner: Agfa HealthCare

2008 PROJECT IMPLEMENTATION TEAM OF THE YEAR
Winner: Xwave Healthcare & Cancer Care Ontario

2008 CORPORATE CITIZENSHIP

+ MULTINATIONAL CORPORATIONS
Winner: Agfa HealthCare

+ SMALL TO MEDIUM ENTERPRISE
Winner: Ormed Information Systems

View 2008 AWARDS GALA PHOTOS

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ABOUT ITAC

The Information Technology Association of Canada (ITAC) is the voice of the Canadian information and communications technologies (ICT) industry. ITAC represents a diverse ICT community spanning telecommunications and internet services, ICT consulting services, hardware, microelectronics, software and electronic content. ITAC's community of companies accounts for more than 70 per cent of the 572,000 jobs, $140.5 billion in revenue, $6.0 billion in R&D investment, $31.4 billion in exports and $11.4 billion in capital expenditures that the ICT industry contributes annually to the Canadian economy. ITAC is a prominent advocate for the expansion of Canada's innovative capacity and for stronger productivity across all sectors through the strategic use of technology.

To view a list of ITAC Members click here.

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TELUS named 2008 Canadian Health Company of the Year

ITAC Award presented for excellence in corporate initiatives, customer satisfaction and exceptional quality of service

Toronto, ON, November 21, 2008 — On the heels of a significant announcement around its continued commitment to the healthcare sector, the newly branded TELUS Health Solutions has been named the 2008 Canadian Health Company of the Year by the Information Technology Association of Canada (ITAC).

The award, presented at a gala event in Toronto, honours TELUS as a distinguished for-profit healthcare information technology company that has demonstrated excellence in the Canadian health informatics industry within the past 12 months. TELUS was nominated as a private sector company that has excelled in corporate initiatives and client satisfaction, delivering exceptional quality of service.

“It is a tremendous honour for the TELUS team to be named Health Company of the Year by ITAC,” said Joe Natale, president, TELUS Business Solutions. “The transformation of healthcare in Canada is a huge undertaking that will take the collaboration of all key stakeholders - government, healthcare providers and business. At TELUS, we are committed to taking a leadership role in healthcare transformation through leveraging innovation and the strength of our people.”

The award was presented on behalf of ITAC Health, formerly the Canadian Healthcare Information Technology Trade Association (CHITTA), and was specifically focused on the successful implementation of TELUS iScheduler and Call Centre Anywhere at CritiCall Ontario, a 24-hour-a-day emergency referral service for physicians across the province of Ontario.

"The TELUS solution will allow CritiCall to invoke the entire circle of care anywhere and anytime, regardless of physician or patient location," said Kris Bailey, executive director of CritiCall Ontario.

“Without a doubt, IT has the potential not only to save lives by providing doctors, nurses and other healthcare workers access to essential information, but to lower the overall cost of healthcare,” said François Côté, president, TELUS Health Solutions. “We are proud that TELUS Health is at the forefront of the eHealth movement, and couldn’t be happier about the acknowledgement of our leadership through this distinguished award.”

TELUS Health Solutions has years of expertise in successfully implementing healthcare applications and information communication technology processes through industry leading solutions and consulting services to customers in Canada and around the world. It is backed by more than 1,500 TELUS Health Solutions team members including healthcare professionals. For more information, please visit telushealth.com.

About ITAC Health
Representing more than 120 Canadian ICT companies that are actively involved in the health sector, ITAC Health is the healthcare division of ITAC, the Information Technology Association of Canada. Our mandate is to provide our members with access to public and private leaders of the healthcare industry, provide access to information and collaboration opportunities, and provide a consolidated voice for the industry when interacting with local and international governments in the promotion and governance of our industry. As a consolidated, single voice, members help influence the Canadian healthcare ICT market through active participation in our standing committees and various working groups.

About TELUS
TELUS (TSX: T, T.A; NYSE: TU) is a leading national telecommunications company in Canada, with $9.5 billion of annual revenue and 11.5 million customer connections including 6 million wireless subscribers, 4.3 million wireline network access lines and 1.2 million Internet subscribers. TELUS provides a wide range of communications products and services including data, Internet protocol (IP), voice, entertainment and video. In support of our philosophy to give where we live, TELUS, our team members and retirees have contributed $113 million to charitable and not-for-profit organizations and volunteered more than 2.1 million hours of service to local communities since 2000. For more information about TELUS, please visit telus.com.

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

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

Read original article.

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

Eventually, Information Technology (IT) May Make Practice of Medicine More Satisfying

Almost every plan to improve health care -- from members of Congress, insurers, employers and President-elect Barack Obama -- contends that new IT, including electronic health records, electronic prescribing and telemedicine, will save time and money.

But will health Information Technology (IT) make practicing medicine more satisfying?

Eventually, but it's going to take a while, and it won't be easy or inexpensive, according to a representative of the Healthcare Information and Management Systems Society and the president of The Physicians' Foundation, which recently released a national survey measuring doctors' opinions about the profession.

The Physicians' Foundation survey indicates widespread frustration among primary care physicians. They feel overworked and nearly half of them plan to cut back on the number of patients they see or quit medicine entirely, according to the survey.

Neither John Maese, chair of the HIMSS Ambulatory Care Steering Committee and president of Quality Physician Services in Brooklyn, N.Y., nor Lou Goodman, president of The Physicians' Foundation, see health IT as a panacea for all that ails the medical profession, but both agree it can be a valuable tool.

Goodman, however, is worried there soon may not be enough primary care physicians, regardless of new technology.

"Going into this project we generally knew about the shortage of physicians," Goodman said, adding, "What we didn't know is how much worse it could get over the next few years. The bottom line is that the person you've known as your family doctor could be getting ready to disappear -- and there might not be a replacement."

Initial Investment of Time and Money
Maese said that health IT can help make the practice of medicine more rewarding but that it takes an initial investment of time and money.

"Initially, technology slows you down," Maese said, adding, "So in the face of declining reimbursement that requires you to see more patients per hour, it can be very frustrating to start up with technology."

Maese said, "Younger physicians who have grown up with a computer find it easier to transition to technology." He added, "Older physicians who do not have that experience initially have to carve out time to learn basic computer skills and then the new software."

In its survey, mailed to 270,000 primary care doctors and 50,000 specialists, The Physicians' Foundation asked, "Have you already implemented an electronic health record?" Among the almost 12,000 responses, 72% answered "no" and 28% answered "yes."

"Time, money, personnel and expertise are the major barriers to widespread adoption of technology in medical practice," Goodman said.

Of those who said they had not moved to EHRs, 77% cited lack of money, 69% cited lack of expertise or other resources and 61% cited lack of time.

Although the survey did not specifically address physicians' opinions of health IT, Goodman said his sense is that most physicians look forward to the advancement it represents.

"I think many physicians are very interested in adopting new technology and many have already taken the next step," Goodman said.

"There is great interest and continued excitement over the potential improvements technology holds. [Health IT] is clearly on the front burner in the early discussions in the Obama cabinet as part of its proposed health system reform efforts," Goodman noted.

The Physicians' Foundation was founded in 2003 as part of a settlement in an anti-racketeering lawsuit involving insurers, physicians and medical societies. The foundation conducts research and acts as an advocate for physicians and physicians groups.

More Seed Money Needed
Maese and Goodman said increasing payments to help offset investment costs for technology would help make technology spread more rapidly.
"We believe that the large initial investment in technology without the concomitant adjustment in payment rates makes it very difficult for private practice to install an [EHR]," Goodman said, adding, "Even large group practices have seen challenges with questions of interoperability and the significant outlays of time and money required to get a system up and running."

Maese agrees. "There needs to be increased financial support for the EMR, the initial purchase and the ongoing maintenance of the EMR," Maese said, adding, "Currently, small practices, where most health care is delivered, do not have the economic ability to purchase the hardware, the software as well as the additional expense of electrical wiring upgrades and high speed Internet access to make an [EHR] work."

Five Ways Information Technology (IT) Can Help
Once the initial learning curve is negotiated and hardware and software are in place and working, Maese lists the following five ways new technology can make a physician's life more satisfying:

• "The computer may not save them time but there is a feeling that there is a higher quality of care rendered and better patient safety. This is very satisfying to the physician."

• "Reduction of the hassle factor. You are able to deal with insurance or formulary issues at the point of care so you do not have to go back after the patient has left the office and redo the request for a medication or a service."

• "Improved time management or flexible time management. Electronic medical records that can be accessed from home gives the physician more flexibility. The physician can attend meetings and events without having to go back to the office to complete medical records or carry charts back and forth to have them completed."

• "Better access to care for patients in an emergency. Electronic records can be accessed from anywhere."

• "More family time. Once the physician has completed seeing all the patients, the physician can go home, see the family and complete chart documentation remotely. In addition, follow-up care, checking diagnostic tests and X-rays can be done at home, which again allows the physician flexibility to spend more time with the family, which helps increase overall lifestyle satisfaction."

by George Lauer, iHealthBeat Features Editor
Read Original Article.

New Brunswick’s Task Force on Personal Health Information (PHIFT)

Co-chaired by Jean-Guy Finn and Kevin Malone, the Province of New Brunswick’s Task Force on Personal Health Information (PHIFT) was created in May 2008 to consult with New Brunswicker’s and advise the minister on new legislation to regulate the collection, use and disclosure of personal health information.

In October, 2007 New Brunswick’s PHI Task Force released a report entitled Balancing Privacy Rights and Access Requirements. The recommendations in the report strike a good balance between the protection of personal health information (PHI) and the need to use this information appropriately in order to improve patient care and, secondarily, better manage the health care system.

PHIFT Mandate
Co-chair Bios
Personal Health Info
Access
Consent

PUBLICATIONS
Consultation Guide
Backgrounder
Task Force Report

Province of Manitoba | Provincial Electronic Health Record (EHR) Resources

Manitoba eHealth Vision
The Manitoba eHealth Program will facilitate the improvement and enablement of healthcare delivery transformation through the use of information and communication technology. Manitoba eHealth offers a single integrated organization capable of providing province-wide solutions under the direction of the Manitoba eHealth Board.

Manitoba eHealth Mandate:
• Begin the process for integrating health care systems across regions and care-sectors
• Improve and expand health care services by managing information and communication technology as a single organization capable of achieving economies-of-scale, province-wide
• Improve the efficiency and effectiveness of Information and Communications Technology (ICT) services by leveraging the benefits of a centralized delivery model.

Through a coordinated provincial approach, Manitoba eHealth is working with health care professionals to plan, design and build the necessary systems that will lead to a provincial Electronic Health Record (EHR).

Projects in Progress
• Emergency Department Information System (EDIS)
• Hospital Information System Project (HISP)
• SBGH
• Provincial HISP / Long Term Care Planning
• Interoperable Electronic Health Record (iEHR)
• Provincial Client Registry
• Provincial Lab Information System
• Provincial Radiology Information System / Picture Archiving and Communications Systems (RIS / PACS)
• Utilization Management System (UM System)

Projects Completed
• Clinical Supply Chain Information System (CSCIS)
• Lab Information System (LIS) – Winnipeg Region
• Primary Data Centre (PDC)
• Security Planning
• Sterile Instrument Tracking System (SITS)
• Surgical Information Management System (SIMS)

Canadian Regional e-Health/EHR Authorities

Newfoundland and Labrador



Prince Edward Island




Nova Scotia



New Brunswick



Ontario



Quebec




Nunavut



Yukon



Northwest Territories





Manitoba




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


Saskatchewan



Alberta




British Columbia



Health Canada



Canada Health Infoway

The Modern Face of Healthcare: The Wired Patient

Occasionally in our lives there is an alignment of powerful forces that cause a technology, a theory, or a new product to resonate with the broadest of audiences. One topic that is consistently debated and the highest priority on the agenda of citizens, public servants, and nations at large is healthcare ---and in particular how the advent of the internet and communication technologies is changing the way we deliver care.

The aim of Information and Communication Technologies (ICT) for Health (also known as eHealth) is to significantly improve the quality, access and efficacy of healthcare. ICT for Health describes the application of information and communication technologies across the whole range of functions that affect the health sector. Whether attempting to heighten prevention, detection, integration, or extend patients self-management tools---today’s healthcare delivery paradigm is clearly shifting to focus on connecting individuals rather than infrastructure. Moreover, today’s savvy consumers are demanding better health services and a more personalized service delivery model that places them at the centre of new models of connectivity for improved communication and collaboration.

Harris Interactive, on behalf of The Commonwealth Fund Commission, recently surveyed a random sample of 1,004 U.S. adults (age 18 and older) to determine their experiences and perspectives on the organization of the US health care system and ways to improve patient care. Eight of 10 respondents agreed that the health system needs either fundamental change or complete rebuilding—citing difficulties accessing care, poor coordination of services, and administrative hassles. In addition, the survey found that one of three adults has experienced inefficient or unnecessary care in the past two years. Granted this was not a Canadian study, however, many of the systemic issues seen south of the border are equally relevant here in Canada.

What is consistent in both countries is that Patients are increasingly seeking services that empower them to take an active role in managing their own health. Empowering patients to take more control over their health extends to those actions individuals and take for themselves, their children, 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.

Patient self-care is 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. What is clear is that people are going online today to share personal health experiences and learn from others with similar experiences or conditions. This shift promises to evolve traditional models of medicine toward a patient-centric model and aims to effectively bridge the gap between caregivers and patients – before, during, and after the hospital stay. The good news is that the value proposition is mutually advantageous, as both Patients and Healthcare delivery organizations reap the benefits of self-care initiatives.

Patient Collaboration
There is a notable growth in patient collaboration in determining support and direction. And this will only increase as the tools that enable and track insight and participation continue to improve.

When patients participate directly in determining how they are engaged, and are provided personalized content in their preferred channel, Healthcare delivery organizations are simultaneously extended the ability to capture and share information, understand their stakeholder’s unique needs, and improve the overall patient experience.

Information and communication technologies (ICT) offer numerous potential benefits in terms of improvements for patients, health and elderly care professionals and decision-makers. Citizens, patients and relatives must have quick, trouble-free access to quality-assured information on health care provision and health concerns, as well as personal data on their own care, treatment and health status. They must also be able to contact care services via the internet for assistance, advice or help with self-treatment.

What is absolutely clear is that Information and communication technologies are changing health care delivery and are at the core of effective, responsive health systems. These technologies are key to connecting people, information and research to improve health in countries, and ultimately, healthcare organizations extending their patients participatory tools in their own care path will have a much deeper understanding of their patients needs, and will have gone significantly farther towards building and maintaining patient trust and confidence.

Today, it’s truly all about the Patient and one-to-one engagement is the new competitive advantage.

Thought Leader Series | "Patient Portals"

by Peter Kuhn | October 08, 2008

According to the Deloitte 2008 Survey of Health Care Consumers, over 70 percent of consumers want their hospital to provide online access to an integrated view of their medical information, including test results, doctor visits and hospital stays. Yet the percentage of hospitals that have deployed a true patient portal is still in the single digits.

Although it may appear that the healthcare industry has been devoid of motivation for the past 10 years, hospitals have been investing heavily in technology such as hospital information systems, laboratory systems, picture archiving computer systems and other solutions that enable electronic connectivity for clinicians within the organizations. These investments are already beginning to show results in terms of productivity and cost savings.

However, this is just the start of the process of patient data integration. Even though some hospitals have successfully linked major disparate systems within the hospital, few have fully integrated their environments, such as pharmacy interaction for closed loop medication reconciliation and seamless access to physician practice-based electronic medical records (EMR), the source of the majority of a patient’s encounter history.

Connecting to the multitude of EMRs can be a real challenge for hospitals. For example, if there are 1,000 referring doctors in a given area, and approximately 300 different EMR solutions in the industry (depending on who you ask), it is reasonable to assume that a hospital might need to interface with 15 distinct EMRs within just one community. Adding to the complexity is the fact that the average patient sees three to five different providers. This is all compounded by the relative newness of system and interoperability standards, which has erected significant speed bumps for risk-averse hospital systems.

Next Up ... Patients
Once hospitals link their inpatient hospital systems with outpatient (physician) EMR systems (still a dream for many healthcare systems today), the next step is to extend the network to include patients. Several factors motivate hospitals to accelerate this step. First, the expanding adoption of high-deductible insurance plans by employers is forcing fiscal and care decision making upon consumers. With this increased level of responsibility, consumers are demanding greater transparency in costs and improved value of the care delivered by providers. This is well supported by industry statistics: For example, the Deloitte 2008 Survey of Health Care Consumers shows that 64 percent of consumers wish to use Web sites to research the quality of hospital care, 62 percent wish to verify the prices of hospital services and 59 percent wish to view information about health conditions and treatments.

Consumers who are often drafted into the consumer-directed healthcare model through their employers have become empowered patients that expect value for their time and money. As indicated in the Deloitte study, 68 percent are interested in same-day appointments and 60 percent want online appointment scheduling — and they are willing to pay for the convenience. In fact, one in four consumers would pay extra for online access to these integrated services and patient information.

As insurer reimbursements continue their downward spiral, this new source of incremental revenue is a strong motivation for providers, as is the competitive advantage that it supplies in the increasingly crowded marketplace. Additionally, hospitals are beginning to realize that the more extensive the integration of actionable patient information and online access, the greater return on investment they experience. Large hospital systems in cities such as Philadelphia, Chicago, Seattle, Detroit and the Washington/Baltimore region are making some of the greatest strides in this area.

Disruptive Technology?
An interesting development occurred with the entrance of Microsoft and Google into the healthcare arena. Their ubiquitous consumer outreach has introduced the masses to the concept of medical information access at a rate and scope not achievable by a healthcare organization without millions of additional dollars spent in patient communications. Now, EMRs and personal health records are some of the hottest concepts within consumer media, compelling patients to approach their physicians and hospitals to ask for the ability to view and access their medical information and healthcare services. Consumers now know that these services exist — and they want them.

This situation is similar to the shake-up that occurred in the travel industry, triggered by the consumer-focused, online services provided by Expedia and similar travel portals. Traditional agencies had to adapt and offer comprehensive online services or be left behind. Google and Microsoft have shaken the healthcare tree, and it’s time to evolve or fall to the ground.

But even those two corporate behemoths are not supplying all of the legs of the patient data stool. They are offering free medical record storage, but with limited integration to all the disparate sources of medical data. Their solutions provide limited benefits related to enhanced clinical workflow and productivity. But they do point the industry to that which it lacks — access combined with actionable data.

Unfortunately, some hospital organizations may pause once they provide basic access to data, without providing a means to act upon that data. Patients wish to see their test results, but then they need to schedule a follow-up appointment, ask questions and request prescription refills. This is the actionable functionality that is key to achieving the maximum workflow, quality and safety benefits with these integrated systems.

Significant Savings
We have seen a 3-to-1 variance when comparing the use of phone-based services to online services. On average, the provider’s staff spends three minutes on the phone scheduling an appointment; yet that same action would take a patient one minute to accomplish via a patient portal, without requiring assistance from hospital personnel. Multiplied across patients, the time savings for both parties is substantial. Additionally, the patient has the convenience of scheduling an appointment whenever they have time, whether it is at 2 a.m. on a weeknight or at 10 a.m. on a Sunday. No wait, no hassle and all the benefits of online services — e-mail reminders, online calendars and more.

For clinicians and staff, these online requests can be responded to during non-peak times so that hands-on patient care can be their first priority, contributing to improved patient outcomes and safety. Furthermore, the streamlined workflow enabled by the portal enhances all phases of the continuum of care.

Word of Mouth Goes Viral
Lastly, the satisfaction delivered to the patients, as well as to the clinicians, should not be underestimated. Just like the old-fashioned word of mouth, happy patients will send links to helpful information found on patient portals to their friends, relatives and colleagues. Some portals even enable patients to provide family members with authorized access to their private medical information. Otherwise known as viral marketing, by encouraging patients to forward information about the given hospital’s impressive patient portal services, hospitals have tapped into one of the most powerful and cost-effective marketing methods for attracting future patients.

Of course, any change will face some resistance. Similar to traditionalists that prefer to walk inside the bank and stand in line to deposit their checks, there will be some patients that are not immediately comfortable with online interactions. However, soon we will see corner store kiosks where we can view and access our medical records, and communicate with physicians and office staff. It’s already started.

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Peter Kuhn is President of MEDSEEK, a provider of enterprise eHealth solutions.

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Healthcare Posturing: Where the parties stand on your health

Progressive Conservative Party
The Harper government has not yet released its electoral platform, but has pointed to its record as proof that it's committed to a "publicly funded, universally accessible health-care system."

The Conservatives say they have invested $612 million in new funding to help provinces slash patient wait times. The government has provided $400 million to the Canada Health Infoway (a non-profit organization) to develop electronic health records, and thus reduce some medical errors. The party also says it has boosted funding for new training spaces to address the shortage of doctors and nurses but hasn't provided any figures on its website.

The Liberal Party
Liberal leader Stéphane Dion has pledged $900 million to establish catastrophic drug coverage. The idea is to ensure that Canadians living with a life-threatening or chronic illness wouldn't have to worry about paying out of pocket for costly medications that are not covered under provincial plans.

The Liberals are also promising to invest $420 million to create a "doctor and nurses fund" to address the acute shortage of health professionals. The fund would be used to train more doctors, nurses and medical technicians as well as providing financial support to assist foreign-trained health professionals in obtaining their Canadian certification more quickly.

The New Democrat Party
The NDP is betting that Canadians will like its plan to spend $1 billion over the next five years to educate and graduate more doctors and nurses. Overall, the NDP hopes its plan will swell the ranks of doctors by 1,200 positions as well as adding 6,000 nurses to hospitals and clinics. The plan would also encourage more medical students to stay in family practice rather than pursue a career as a specialist. What's more, the NDP has called for universal prescription drug coverage and measures to cut drug costs at source.

The Bloc Québécois
The Bloc Québécois has not made any specific campaign promises on health, other than vowing to defend the rights of Quebec. For example, the Bloc says it will continue fighting against conditions imposed by the federal government on funding transfers to Quebec for health, education and social programs. Health, since it's a provincial jurisdiction, is something that Bloc leader Gilles Duceppe "doesn't think is germane to the federal government to begin with," said Antonia Maioni, of McGill University.

The Green Party
The Green Party has issued a detailed "green paper on health promotion" with an emphasis on a cleaner environment. It has proposed an innovative policy of health tax shifting. The party would grant a "GST health benefit reduction" for goods and services that promote health like sports equipment and fitness centre fees. The Greens give no numbers on the percentage reduction. The party has also promised a corporate health tax reduction to companies that create "healthy workplaces." Again, no specific numbers.

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Saturday, September 27 | Read original article.

REACHing for Leading-Edge Patient Care with e-Health

By Dan Germain, VP, CFO and CIO at the Credit Valley Hospital and former e-Health lead for the Mississauga Halton Local Health Integration Network (LHIN.)

In Ontario, very few hospitals can share their disparate Electronic Health Records (EHRs) between providers or with patients/clients. To facilitate sharing of patients’ EHRs among physicians and clinicians, The Credit Valley Hospital (CVH) joined William Osler Health Centre (WOHC) and Halton Healthcare Services (HHS) to establish an electronic clinical portal. Trillium Health Centre (THC) and Headwaters Health Care Centre (HHCC) have also entered into this partnership and will go live in the next few months extending the Rapid Electronic Access to Clinical Health (REACH) EHR initiative to all hospitals within two LHINs serving a catchment area of 1.8 million Ontario residents (about 5% of the total Canadian population). This existing collaboration between six physical hospital sites in the Peel and Halton regions and two LHINs – the Mississauga Halton LHIN (MH LHIN) and the Central West LHIN (CW LHIN) – is unprecedented and a landmark partnership in the Province of Ontario.

The REACH Clinical (EHR) Portal enables all associated sites’ clinicians to have instant access to longitudinal patient health information including but not limited to allergies and alerts, lab and diagnostic test results, diagnostic images and reports, pharmacy data, transcribed notes, scanned images, progress reports, and other important health-related information. A thorough Privacy Impact Assessment was also perforemed to ensure REACH meets all Ontario privacy standards.

At each constituent hospital, patient data is easily accessed today through our secure network solution and consolidated into one customizable, patient-centric view. Based on a federated data-model, patient data remains in its original format on its respective (legacy) vendor IT system, allowing for all systems to be leveraged across multiple domains, rather than replacing them. Additionally, using a federated data-model ensured implementation of the REACH clinical portal was extremely fast and inexpensive especially when compared to other more complex solutions. The partnership between REACH Hospital stakeholders not only enhances patient safety and satisfaction, it provides an intuitive web-based interface that is accessible anywhere.

The REACH portal was created using MEDSEEK in partnership with Agfa HealthCare, both leading providers of enterprise-wide e-Health solutions. This simple portal solution is also vendor-agnostic, so the system is compatible with almost all health information systems, diagnostic imaging vendors, and other suppliers. “Over 160 interfaces are available on a plug-and-play like basis,” says Dan Germain, Vice President, Chief Financial Officer and Chief Information Officer at CVH.

Dr. Paul Philbrook, CVH’s Chief of Family Medicine and Chair of the Central West – Mississauga Halton Community Family Medicine/Public Health Network of Physicians, along with his colleagues, championed the idea of allowing affiliated physicians the opportunity to access their patient records across all local hospital sites. He explains, “The REACH portal is a welcome advancement of access to patient information and integration locally. This will enhance patient care and safety.”

Germain, also former e-Health lead for the Mississauga-Halton LHIN, further explains, “The REACH portal was created for physicians and clinicians to improve patient care and provide real-time access to existing patient records across the region. Although more time is needed to determine the quantifiable benefits of such a solution, it is expected that the REACH Portal will assist in avoiding potential medical errors and offset the possibility that other critical information is inadvertently missed for elective, emergency admissions or outpatient visits. Saving just one life by using this system will pay for itself.”

To date, the REACH EHR portal is getting over 9,000 views per month within the Mississauga-Halton and Central West LHINs---with one-third of those views made by Physicians looking at patient data from other hospitals. Over 1,000,000 outpatient visits and 100,000 discharges per year are now available within the REACH portal at this time. “The clinicians who are accessing patient information via the REACH portal love it,” says Germain. The portal has the ability to consolidate information about a patient/client from other sources (e.g., Community Care Access Centre’s), but currently, the focus is to bring more hospitals on stream and ensure as much clinical data is contained in the portal as needed.

The Mississauga-Halton and Central West LHIN's are fortunate in securing both the commitment of all regional hospitals to join the REACH portal, and also engaging a vendor solution that was both comprehensive and transferrable outside the walls of any specific site. This collaboration between regional hospitals is a stepping stone toward the overall e-Health goals for the province of Ontario, for example, building a standardized methodology to identify each unique patient and then consolidate electronic health care data from a variety of sources (e.g. hospitals, private laboratories, pharmacies, nursing homes.) It should also be noted that Hamilton Health Sciences and the Scarborough Hospital are also using the Medseek portal (distributed by Agfa HealthCare in Canada.) Ottawa-area Montfort Hospital has also signed on, but have not gone live yet. REACH will be ready to plug-and-play into Provincial EHR Initiatives once available.

We keep hearing from patients that they want to be more involved in their own health care. "Providing patients with electronic access to their health record and wellness information– that’s our next goal,” says Germain. “We can make our collective vision happen a bit sooner – anything is possible." Now that our disparate Clinical Information can be accessed and leveraged, a REACH Patient Portal is on the horizon. Germain explains that this Patient Portal initiative will be especially beneficial to those managing chronic disease prevention and that it is imperative that that patients have access to their own health records in a secure manner, as well as access to reliable health and wellness information.

Dan Germain is the Vice President, Chief Financial Officer and Chief Information Officer at The Credit Valley Hospital.

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PHR: WILL CONSUMERS REALLY HAVE A CHOICE? THE NEW ENTRANTS INTO THE PERSONAL HEALTH RECORDS (PHR) MARKET MAY PROVIDE COMPETITION.

Sept. 8, 2008 | By Barbara A. Cox and Marysol Imler

Since 2004, the US has been energized in trying to develop and provide personal health records (PHR's) for all consumers. During the last 4 years, many models have emerged. Several of the models have failed for a variety of reasons, including lack of a sustainable funding model. In addition, many of the interoperable health record models have not included the involvement of the individual consumer -- the person for whom these models are intended to be used by.

Over the last year, a new type of solution provider entered the PHR market. Different than the typical vendor that has been known to service the health industry, these solution providers are vendors known for addressing the consumer market. The new entrants (Google Health, Microsoft HealthVault and Revolution Health), may provide the type of competition and consumer controlled model that will help the industry evolve at a more rapid pace than what has been happening to date. With these new vendors, will control be transferred from the care provider to the consumer as it should be if health care is going to transform?

WINDS OF CHANGE
Are these products bringing about a refreshing change to the industry? While these products are much easier to use and implement than the traditional federated or scattered model of clinical data integration that has consumed the nation over the last 4 years, they appear to be in the first generation of product releases. Hopefully, the industry will see better things to come.

Microsoft, Google and Revolution Health are intended to support the consumerism wave in giving the individual a choice about the products they choose to use and the groups or people that can view their information. For an individual to receive full value for these products, they must have interoperability with that person's care providers' clinical systems. Unfortunately, the consumer is still limited by whether or not their own personal physician groups choose to participate with these products. Physicians and hospitals around the country are making choices on which platform to align with, and it is doubtful that an organization will choose to participate with multiple platforms.

Until the platforms achieve interoperability, a consumer will not truly have choice in the matter of determining which set of products they want to use. For instance, if your physician is associated with the Cleveland Clinic, you can receive the full value of having your data transferred into Google and populated with other services participating with Google, or you can choose to populate the data manually. Then, the individual is limited by the functionality provided by Google. Should you want to use a service that is associated with Microsoft HealthVault, you will be out of luck unless you choose to manually load the data yourself, which presents another set of challenges with providers regarding the accuracy of the data.

HOW ARE THE PHR PRODUCTS DIFFERENT?
Microsoft HealthVault is truly a platform. With this solution, business partners provide the application functionality. HealthVault is the keeper of the consumer demographics information and personal profiles to establish security and user identity. The consumer then chooses to use or buy services from a number of different vendors who provide value to the individual.

Google Health has a light-weight PHR embedded with its platform. The platform also has personal demographics and a personal profile for security and personal identity. While Google also has business partners in which an individual can choose to use, there is a limited supply of PHR solutions available.

Revolution Health is a robust PHR with a lot of educational content to add value for the individual. It is positioned as a tool to help employers and their employees. However, when conducting research, it was difficult to view the data integration possibilities with providers due to technical difficulties on the Web site.

CONSUMERS AND CHOICE
What will have to happen for consumers to have choice? The vendors and the care providers must evolve to support a consumer controlled environment. Consumers need to communicate to their care providers about the tools they want to use. The care providers will set up the link in their system and automatically send the clinical, administrative and financial data to the designated choice. For a seamless transmission of data to occur in a cost effective manner, the data transmission will need to follow strict standards that every vendor will adopt. Today's standards are left to the interpretation of the organizations interacting.

When the industry agrees to adopt a consumer control approach, then consumers will have choice. Until that time, the care providers are still in the driver seat, even with the new emerging consumer platforms that Microsoft HealthVault, Google Health and Revolution Health provide.

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Read original article.
Barbara A. Cox is Senior Principal, Noblis Center for Health Innovation. Marysol Imler is a Consultant for Noblis Center for Health Innovation.

CANADIAN TERRITORY RECEIVES FUNDING FOR REGIONAL EHR INITIATIVE

September 12, 2008 | Nunavut, a territory in Canada, recently received funding for its electronic health record project from Canada Health Infoway -- a federally funded, independent, not-for-profit organization -- Healthcare IT News reports.

Canada Health Infoway has provided 7.4 million Canadian dollars, or about $7.07 million, for the second phase of the territory's e-health program. The investment is part of an 11.6 million Canadian dollar, or about $10.9 million, effort between the territory and Infoway to support EHR adoption throughout the territory. EHRs will help Nunavut provide residents with faster access to care and reduce the turnaround time for diagnostic imaging.

Officials expect Nunavut's EHR system to go live by 2012.

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Original Article.