CANADIAN'S AND THE RUSE OF HEALTHCARE 2.0

Healthcare is the world’s most information intensive industry. Every day this industry produces massive volumes of data that, if properly used, can improve clinical practice and outcomes, guide planning and resource allocation, and enhance accountability. Electronic health information is fundamental to better health care. There will be no quantum leap forward in health care quality and efficiency without high quality, user-friendly health information compiled and delivered electronically.

The task of building an information network that patients, providers, managers, and policy-makers can use to improve decision-making at all levels is truly daunting (and the health information “agenda” competes with innumerable other claims on resources.)

That said, Canada’s Healthcare Informatics arena is rapidly changing, primarily due to growing public and private investment in Electronic Health Information Systems (EHIS). At the same time, a recent economic study (November 2009) identifies a serious need for increased labor and skills amongst Canadian Health Information (HI) and Health Information Management (HIM) professionals over the next five years. To compound further, there are fears in both the private and public sector that the successful implementation of EHIS systems is potentially jeopardized due to lack of qualified human resources. Add to this - - issues around Canada Health Infoway Funding, a limited and flawed EHR blueprint, Federal and Provincial politics, lobbying, posturing, competition, and (yes) corruption - - and it’s easy to see how a feast or famine (all or nothing) environment has been established.

From a consumer standpoint in Canada, advancing patient care has also unfortunately been tied directly to those vendors that have the bandwidth to extend a provincial or national solution (even if those platforms are antiquated and in many cases not standardized). This discussion (and subsequent funding) is entirely based on resources, and while absolutely a relevant conversation - - in practice - - has only left Canadian’s with a sub-par platform and an increased tax-burden.

So, while increasing evidence (and PR buzz) attempts to illuminate progress in extending a Canada-wide EHIS - - it’s really only proven to be lip service. As political pressures mount, huge contracts are extended to vendors who are in many cases no more equipped to deliver an integrated EHIS than a local start-up.

The best example one might extend related to the state-of-the-union of Canadian EHIS is from the “Wizard of Oz”.  One might think that it’s only a matter of time before Canadian citizens get wise to the kick-back’s, cost over-run’s, deception, and general systemic corruption in Canadian EHIS. Let’s not even get started on the role of “Consultants” in all of this. The unfortunate challenge is that, unless one is deeply entrenched in this sector for a number of years - - most investigations are only typically scratching the surface.

Neither the Canadian Government nor any of its elected bodies have yet to even get close to the real issues (and savvy multi-national vendors are well aware of this and capitalizing on it.) When Canadians finally pull back the metaphorical ‘curtain’ to see the ‘Wizard’ pulling furiously on ropes and levers - - to attempt to evidence progress - - they’re going to wonder whose hand was on the wheel?  Just take a look at the long, detailed (and growing) list of Federal and Provincial resources (i.e. dollars) allocated to accomplishing specific EHIS tasks that are never completed or even accounted for.

To be continued...

Province of Ontario: Ex-eHealth Chair quits ... again

August 14, 2009 | The STAR | QUEEN'S PARK BUREAU

Hudson's resignation from health ministry comes as PM wades into spending scandal. Premier Dalton McGuinty's go-to man in reducing health-care wait times has left the government – less than two months after being replaced as chairman of the scandal-ridden eHealth Ontario.

Acclaimed neurosurgeon Dr. Alan Hudson last week resigned from his full-time, $292,653-a-year job leading the province's efforts to reduce delays in cancer and cataract surgery, diagnostic imaging, cardiac procedures and hip and knee replacements. Reached on vacation with his family, Hudson said in an interview that he consulted Health Minister David Caplan and others before deciding to step down last Friday after five years in the job.

"Everyone wanted me to stay on, but I am not going to stay on until I die," said the 71-year-old Order of Canada recipient. "It is time for me to do other things – play with my grandchildren, do some travelling."

The news, first reported on thestar.com, came as Prime Minister Stephen Harper yesterday waded into the eHealth spending imbroglio – in which consultants who were paid as much as $3,000 a day raised public ire by expensing tea and Choco Bites cookies – with a caustic rebuke of McGuinty for costly delays in creating electronic health records for Ontarians.

"The federal government had in its budget considerable funds available for the (Canada) Health Infoway, for the expansion and pushing forward of the project to make health records in this country electronic, so I obviously would encourage the provincial government to get on with rectifying the problems in that area."

Senior provincial officials countered that the federal government has not yet given Ontario the cash for electronic health records. Because he was on contract, Hudson will not receive a golden handshake like the $317,000 given to departed eHealth chief executive Sarah Kramer, who finally broke her silence yesterday with an acerbic statement slamming the media and health ministry bureaucrats.

"There's no severance," said Terry Sullivan, chief executive of Cancer Care Ontario, where the wait times offices are headquartered. He noted Hudson was rattled by the eHealth experience, which became a major political headache for McGuinty, prompting him to clamp down on untendered contracts to consultants and the meals and treats they expense to taxpayers.

"He was distressed and troubled by the whole experience. ... I assume that was part of his calculus," Sullivan said of Hudson, crediting him for the innovative wait-times system that began tracking treatment times with an eye to improving them. A replacement for Hudson on the wait-times file has not been determined, but Sullivan urged the government to do so, noting that general surgeries will eventually be added to the list.

Hudson's departure is a further blow to McGuinty's Liberals in the wake of the eHealth debacle, in which revelations of spending abuses have continued to emerge – including an estimated $25,000 spent on writing and tweaking a speech for Kramer. She left the agency in June amid furor over executive perks, big bonuses and untendered contracts that total at least $16 million of taxpayers money. Kramer's 448-word statement issued yesterday appears to have been triggered by McGuinty's declaration Wednesday that it was a "mistake" to put her in the job.

She defended eHealth's hiring of (overtly) highly paid consultants, saying she had to take over a "moribund and deeply troubled and dysfunctional organization." While she acknowledged the expense was "not negligible," she deemed it an "essential investment" in speeding progress to creating electronic health records.

"As with any major change, our efforts were met with strong, intractable resistance and outright hostility in some quarters, including within the Ministry of Health and a few other vested interests in the health care sector," Kramer wrote, also blaming "sensationalized media coverage." She did not respond to requests for an interview.

Hudson defended Kramer's performance, saying she did the best she could to bring electronic health records to the masses. "She is not a dreadful person," he told the Star.
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WAL-MART TO SELL LOW-COST ELECTRONIC HEALTH RECORD SYSTEMS in the US

It seems everybody wants in on the action. Known for its low-cost food, clothing and appliances, Wal-Mart soon will be offering reasonably priced electronic health record systems.

In a story apparently leaked to the New York Times earlier this week, the big box store will join forces this spring with Dell computers and eClinicalWorks, a provider of healthcare information technology, to offer low-cost EHR systems to physicians, The New York Times reports. Systems are expected to only cost $25,000 for the first physician and $10,000 for additional physicians in a particular (non-acute care) practice.

What's included? Dell is offering its laptops and tablet PCs for physicians to use. eClinicalWorks will provide its electronic health record and practice management software. eClinicalWorks is an Internet-based service that also allows physicians to manage billing and registration online. Dell will install the hardware, while eClinicalWorks will be responsible for installing its software on the PCs, as well as for training and maintenance of the system.

A $19 billion healthcare information technology initiative in the recent stimulus package would provide physicians more than $40,000 over several years for implementation of EHRs, according to the Times.

A former Bush administration healthcare IT official told the Times that such low-cost EHR systems from Wal-Mart could be a "game changer" in the industry's efforts to spur adoption of the technology. Long-term care is working with the rest of healthcare to contribute its portion to the development of an electronic health record system. Bush had set a goal of 2014 for the establishment of such a system.

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CALL FOR SUBMISSIONS

ACUMEME is seeking articles, commentary and ideas on the state of electronic health records (EHR) and e-Health 2.0 in Canada. Have something to say? Here’s your sounding board. Anonymity assured. E-mail us at acumeme@yahoo.com.

Government of Canada Supports Electronic Health Record System that Will Save Time and Lives

Wed., Feb. 11, 2009 | OTTAWA, ONTARIO
The Honorable Leona Aglukkaq, Minister of Health, today announced that the Government of Canada, through its Economic Action Plan, is continuing to support the creation of health information systems designed to benefit Canadians by saving time and lives, while also creating economic stimulus.

Support from Budget 2009 will assist Canada Health Infoway in implementing electronic health records. It will also speed up the implementation of electronic medical record systems for physicians, as well as connect hospitals, pharmacies and community care facilities.

"An electronic health record system will improve the safety and accountability of the overall health-care system," said Minister Aglukkaq. "It will save time and lives by reducing duplication, improving the management of chronic disease, improving access to care and boosting productivity. This will result in a positive contribution to Canada's economy, including the creation of thousands of sustainable, knowledge-based jobs throughout Canada."

Many other countries are following Canada's adoption of electronic health records, which give health-care providers a complete picture of their patients' health history and help them to provide better care. Electronic health records will also help to reduce wait times by speeding the flow of information through the system, eliminating duplicate or unnecessary tests, and reducing hospital stays due to adverse drug events. Automated alerts and reminders will help to reduce medication errors and remind health-care providers of necessary tests or vaccinations.

Funding of $500 million announced today is in addition to $400 million in support provided to Canada Health Infoway in Budget 2007. This brings the Government of Canada's total commitment to this initiative to $2.1 billion. Since its inception, Infoway and its provincial and territorial partners have made good progress in making electronic health records a reality in Canada. Across the country, increasing numbers of Canadians and health-care providers are gaining access to health information through secure electronic systems.

"The Government of Canada's continued investment in the development of electronic health record systems across Canada will result in continued modernization of the health-care system, with tangible results for Canadians in every corner of the country," said Richard Alvarez, President and CEO, Canada Health Infoway. "In addition to benefiting the health system, electronic health records are also reducing operating costs and stimulating the economy by creating thousands of jobs."

Canada Health Infoway is an independent, not-for-profit corporation established in 2001 to accelerate the development of health information and communication technologies such as electronic health records (EHR's), telehealth, and public health surveillance systems on a pan-Canadian basis. Its members are the 14 federal, provincial and territorial Deputy Ministers of Health.

See Health Canada News Releases

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Canada Health Infoway Launches new Canadian e-Health Certification

The government-funded organization works to accelerate the adoption of electronic health records in Canada. Its new e-health certification aims to make consumer health vendors bake more security, privacy and interoperability features into their applications.

Canada Health Infoway is launching a new certification service for vendors who create consumer e-health applications. The non-profit organization hopes its new e-Health Certification Service will encourage health IT vendors to take advantage of the considerable progress Canada has made in setting standards and deploying interoperable electronic health records. With interest in consumer health products continuing to grow, ensuring these solutions work well with technologies used to store Canadian health data is essential.

These products can help individuals organize their health information and gather medical records from doctors, hospitals and pharmacies. It can also help doctors keep up-to-date on changes to your digital health records.

“The key word is interoperability and this should be the driving force for technology solutions in all sectors,” John Reid, president and CEO of the Canadian Advanced Technology Alliance (CATA Alliance), said. “In the health care sector, you want solutions and information to be portable from one geography to the other and that’s the whole idea behind these standards.”

Bernard Courtois, president and CEO of the Information Technology Association of Canada (ITAC), also applauded the national standard and said it could boost the confidence of the market considerably.

“It’s a sign that electronic health is making progress and reaching the consumer world, not just the health care system world,” he said. “Canadians will realize that e-health is something they can’t do without in a modern health care system.”

In addition to better interoperability, organizations investing in certified e-health solutions can also expect a high degree of confidence that the products they buy meet stringent security standards. When applying for certification, a vendor will need to fill out a self-assessment form on how well their product meets Infoway’s standards. After passing this stage, vendors will have to “provide an overview of their privacy policy” and “demonstrate very specific test scripts through their applications,” according to Shelagh Maloney, Infoway’s executive director of external liaison.

“Our ultimate goal is that buyers of these systems, especially the health organizations, will make it a mandatory requirement in their buying process to purchase consumer health platforms certified by Infoway,” she said.

Maloney, however, did not want to comment on the specific costs vendors can expect to pay for going through the certification process. Courtois said that whatever the costs might be, they need to be affordable in order to allow smaller companies a chance at becoming certified.

Traditionally, the problem with certifications is that there’s just too many of them, he added, “if you have to obtain multiple health certifications, it can waste lots of time and money, and really doesn’t provide much help for the buyers,” Courtois said. “This makes things tougher for smaller companies, but it’s also an expense for larger companies and it would be naïve to think that the cost doesn’t get factored back into when they sell the application.”

Reid added that by creating cost-effective – but also well-respected – national standard, vendors can truly differentiate themselves and improve the e-health application market.

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White Paper | Electronic Health Information: The Key to Evidence-Based Medicine and Improved Patient Care.

Sponsored by: BEA/Oracle8/ OCT 08.

This (U.S.-based) Government Insights White Paper provides background information on the healthcare industry in the United States and the challenges and opportunities associated with leveraging technology and electronic health information to promote more effective care delivery across a broader patient community.

This paper also highlights two case studies that demonstrate how technology can serve as a key component of effective healthcare by creating the data framework for evidence-based medicine (EBM).

DOWNLOAD WHITE PAPER

Global Snapshot: National and Regional Electronic Health Projects

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.

Global Perspective: Australia’s Electronic Health Record (EHR) Resources

Coalition for eHealth Australia
The Coalition for eHealth was formed to improve the strength and coherence of the voice from those with expertise in eHealth. View Members of the Coalition for eHealth.

The National E-Health Transition Authority (NEHTA) published specifications for both messaging and connectivity architecture which underpin the approach to e-health communications for NEHTA’s ePathology, eDischarge Summary, eReferral and eMedications Management. Strategic policy alignment takes a strong focus on the monitoring and analysis of trends and technology, in order to drive the Australian Governments' e-Health agenda. Read Specifications.

Australian Health Ministers Advisory Council (AHMAC).
In early 2008, Australian Health Ministers, through the Australian Health Ministers' Advisory Council, commissioned Deloitte to develop a strategic framework and plan to guide national coordination and collaboration in E-Health. Read Summary.

HealthConnect Australia Archive

National E-Health Transition Authority (NEHTA) Privacy Blueprint for the Individual Electronic Health Record
The Consumers Health Forum's National E-Health Transition Authority (NEHTA) Privacy Blueprint for the Individual Electronic Health Record considers a range of key issues including governance, audit functionality, sensitivity labels, what controls individuals have over information on the Individual EHR, and secondary uses.

e-Health is a Valuable Tool
As the e-health movement continues to gain momentum across Australia, consumers are playing a greater part in driving the e-health direction to meet consumer needs.

Keeping Consumer e-Health Transparent
Ethics is central to the culture of health provision in Australia; however, when it comes to looking at e-health things can get a bit clouded. This article looks at just one aspect of e-Health and consumer sponsored (and run) websites.

e-Health and the Quality Use of Medicines - Getting Better All the Time
Computers have revolutionized the way pharmacists work, delivering many improvements to consumers. However, e-Health offers ongoing opportunities.

e-Health - A Consumer's View
There are benefits and drawbacks with the development and implementation of e-Health systems, but with consumer involvement, concerns can be addressed

e-Health for Consumers - Practical Strategies
The e-Health strategies were developed out of the CHF 2005-06 Electronic Health Records project for maintaining a high level of well-informed consumer participation and input in the development and implementation of e-Health systems. The strategies also reinforce the need to consider important issues for consumers, such as privacy, governance, and shared decision-making between health providers and consumers, to ensure these issues remain on the e-Health development agenda.

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.

Electronic Health (e-Health) Resources

Online e-Health Literature Catalogue
(Departmental Library, Health Canada)
+ A fully searchable catalogue providing access to more than 4 000 full text reports, papers, periodicals, and journal articles from Canada, the United States, Australia, the United Kingdom and Europe. Topics include telehealth and telemedicine, protection of personal health information, electronic health records, legislation, standards, and major current health policy documents which have an impact on the use of ICTs in health.


Health Technology Assessment (HTA) Database
(NHS Centre for Reviews and Dissemination, University of York, United Kingdom in collaboration with International Network of Agencies for Health Technology Asssessment (INAHTA.))
+ Includes technology assessment publications related to projects being conducted by members of INAHTA. Note: Many of the publications records links to original papers or executive summaries.



Telemedicine Bibliographic Database
(Telemedicine Information Exchange, Portland, Oregon, U.S.A).
+ Bibliographic database which provides access to citations of articles on telemedicine, many with abstracts; frequent updates. Note: Contains over 12,000 article citations with many available for online purchase and delivery.

White Paper: The Critical Role of Integrated Patient Information in the Delivery of High Quality Healthcare

Find out how an SOA-based solution for HIE and interoperability can provide both caregivers and applications with comprehensive and accurate integrated patient information that facilitates the delivery of high quality healthcare. Download the White Paper.

The Promise of eHealth 2.0 | Clinical Portal Technology

The past few years have been busy ones for those involved with automation of processes within the healthcare industry.

As a result of these efforts, 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 systems and processes combined with poor information flow are increasingly resulting in 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 call for a significant restructuring of our 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/ medical records (EHR/EMR) and web-based information exchange.

To put the fundamentals in place requires investment; however, returns would be enormous in the form of improved quality of care, better safety and greater productivity.

Healthcare executives today have a unique challenge in responding to the e-Health call to arms, as even new systems may also create inefficiencies and added risk to patients if not utilized properly. Somehow, leaders must enable their organizations to evolve while simultaneously protecting the financial stability of the institution and the well being of the patients. This includes providing the modern tools, training and support required to move forward and evolve their health delivery platform.

This can be accomplished incrementally by growing the universal understanding of viable, effective web 2.0 e-Health technologies and sharing successes and failures as an industry. There is no longer any choice about joining the e-Health revolution. It is becoming the rule, not the exception—and it’s gaining momentum everywhere.

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. This is why tools have been introduced to help realize the promise of e-Health. A proven portal solution not only leverages, enhances, and augments existing IT investments, but also evolves information delivery platforms towards a more open, vendor-neutral, patient-centric environment.

OUR TANGLED, HIGHLY FRAGMENTED NETWORK
According to Frost & Sullivan, increasing integration is creating the need for a single point of contact to healthcare IT (HIT) systems, which in turn, is driving the e-Health market.

Today's health systems are tangled, highly fragmented networks that often waste a great number of resources by duplicating efforts, leaving unaccountable gaps, and failing to build on the strengths of our health professionals and clinical expertise. With an aging population, extended wait times, and chronic conditions reaching epidemic proportions, our healthcare system will not survive without radical change. e-Health, the application of web-based information technology to healthcare, can profoundly change the way the business of healthcare is conducted— making it safer, more affordable, and significantly more efficient.

However, transforming traditional modes of delivering care will require Health Care Organizations (HCO) to take advantage of the enormous potential offered by information technology in far more complex ways. Previously, e-Health was stalled by interoperability issues and a lack of workflow-driven, secure information exchange. Today however, progressive technology and innovative solutions are enabling unprecedented advancements.

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

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

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


WEB PORTALS: DEFINITION AND DESCRIPTION
From the user perspective, a web portal is technology that allows an individual or user community to gain convenient access to a broad range of information and services through their web browser.

Most HCO’s serve a variety of stakeholder communities, including providers, payers, patients, employees, and consumers. Each of these stakeholder communities benefits from a portal that is targeted specifically to meet their needs, aggregating information of value for them and allowing them to communicate freely with the host organization and each other.

For the hosting HCO, a portal is an integration tool that incorporates service and data management applications with workflows and business processes to present a unified, personalized, and streamlined gateway to their enterprise for its stakeholders. The HCO establishes a portal strategy to offer timely access to real-time information resulting in better customer service that is accessible from a single point of entry, regardless of which system generates the information or where the information resides.

While a provider portal, patient portal, employee portal, and a consumer portal each appear independent of the other, they are clearly interrelated. Since healthcare consumers may be patients, employees, or even providers, their needs will overlap. Therefore, each stakeholder may require access to the others’ data as well as additional common data sources.

A portal solution can serve to aggregate information stored in disparate, incompatible systems using a Service-Oriented Architecture (SOA). SOA describes a product architecture that allows tight integration with underlying applications, without requiring system interoperability. This also allows users to access software functions independent of the underlying platform and/or programming language.

It permits services to be rolled into larger applications that can be incorporated into portals, without locking the enterprise into a specific vendor. While the SOA concept has been around for quite some time, emerging standards-based integration technologies like Web services and XML have recently made it practical. The benefit for your healthcare organization is clear – a SOA enables eHealth while protecting the enterprise’s investment in legacy software. As organizations search for viable tactical path to leverage a Service-Oriented Architecture, many can use portal products as a first step.

EMPOWERING COMMUNICATION
By empowering patients, providing rapid, real-time data access, greater efficiency, and increased patient/physician collaboration, everyone benefits. Although eHealth applications serve the needs of many different stakeholders, there are four major stakeholder groups, which illustrate the value of this solution: patients, physicians, consumers and employees.



In spite of the differences in type and format of information and services each group requires, there is significant overlap and common desire for:
+ A more positive physician/patient experience between clinicians and patients
+ A more satisfying and effective clinical experience for patients and caregivers
+ A more transparent technology experience for all of the stake holders, but particularly the care givers and IT staff, easy to use and easy to maintain
+ Better IT cost control to make the CIO and CFO’s job of keeping costs down easier
+ More referrals and admits because of streamlining and efficiency improvements that expand a facility’s capacity
+ Brand advancement, fulfilling the goals of the marketing department and CEO of improving community awareness and market position
+ Better recruiting retention because of more effective use of staff time and skills, and easier access to human resources and other employee information
+ Improved operations for administrators and clinicians, building on existing skills and significantly reducing unnecessary mundane tasks.

However, while many vendors offer partial solutions, few offer a comprehensive portal communication solution.

Legacy HIS/CIS vendors offer applications targeting information access and management, and while they improve the physician/patient experience and provide operational efficiencies, the needs of the other stakeholders are not addressed.

Traditional web vendors, on the other hand, tend to focus on content management systems that excel at promoting an organization’s brand but leave the needs clinical and operations stakeholders unpreserved.

Somewhat more comprehensive, electronic medical record (EMR/EHR) vendors offer vital elements of the big picture solution, but cannot accomplish the complete transformation that browser-based systems promise.

e-HEALTH EVOLUTION: INTO THE FUTURE
The Gartner Group identified five levels of eHealth development using Portals, the elements that comprise them, and what it takes to move from one level to the next (see figure 1).

Health Care Organizations continue to significantly use portal products to build and deploy a variety of customer, citizen, partner and employee facing enterprise portals.

Portals have evolved through four generations of technology and are embarking on their fifth generation. In the beginning, eHealth bore relatively simple websites that provided new levels of information accessibility to healthcare consumers.

As the technology evolved to Level 2, searchable directories and more interactive features were added, providing dynamic new options for HCO marketing and administration departments. It was possible to promote classes and services, help people find reliable current health information and appropriate specialists, make human resources information readily available to employees, and collect and manage data using the Internet.

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

Level 3 applications required a broader revolution within healthcare from paper to electronic medical records, which was reliant on emerging data standards and the willingness of HCO’s to empower their users with more control and access.

Generation 3 portals enabled systems to handle basic web services. These portal products could consume web services. The addition of workflow, which is a feature of most portal products, introduced a new way to orchestrate composite applications.

Over time, the experiences of the early adopters and results of pilot projects generated sufficient results to compel cautious HCO’s to pursue the promise of eHealth. With Level 3 adoption no longer stalled by technological limitations and the pervasive wait-and-see mentality, the next wave in eHealth is cresting.

Transformational web portals will offer business process management with workflow automation, alerts, and reminders, integration with patient records, medical device uploads and a host of other equally exciting advances. Together, unified data resources and user interaction will radically alter best-practices for patient care and healthcare efficiency.

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

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

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

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

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

Current, partial solutions can be made whole with interpretable portals through which all healthcare stakeholders will exchange information and engage the enterprise regardless of geographical location. Enterprise portals are intended to consolidate and streamline a vast array of information from multiple sources into a single screen. Portal technology enables different IT systems and software applications to communicate, to exchange data accurately, effectively, securely and consistently, and to use the information that has been exchanged, making the most out of your investments.

TECHNOLOGY THAT OVERCOMES: ELIMINATING ADOPTION ISSUES
With billions being invested in the migration from paper to electronic records, rapid ROI is a determining factor on the minds of executives and administrators concerned about their bottom line. Speedy, enterprise-wide adoption is critical for any eHealth initiative to realize the full benefits of their investment.

ELUSIVE RETURN ON INVESTMENT
Delays and patchwork systems negatively impact the organizations’ ROI. Still, adoption continues to be spotty, despite incentives. In part, the gradual adoption curve can be ascribed to common complaints of HIT; accompanying workflow and systems integrations require process changes that can be intimidating. Reengineering the way work is done presents challenges that extend far beyond use of the technology. Changing the enterprise culture and convincing busy professionals to adopt and learn new systems are essential but challenging components.

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

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

CLINICAL SYSTEM INTEROPERABILITY
The fragmentation of legacy HIT systems causes interoperability issues that can undermine an organization’s confidence in their ability to successfully implement a comprehensively integrated web solution. The data systems needed for an outpatient setting require a different level of sophistication than those that regulate admissions, discharges, and transfers within in a large hospital. Each system is defined by unique vendor standards, some of them decades old. These hurdles make a seamless, rapid data sharing format seem out of reach. However, integration can be tackled with the latest web technology.

Using a “virtual electronic health record” (EHR) model, any HCO can connect underlying systems rapidly and cost effectively to deliver views of clinical information through secure, single sign-on, web-browser technology. The virtual EMR is dependent on a decentralized, federated data model. Using this architecture allows HCOs to leverage legacy HIS/CIS investments, avoiding the ongoing maintenance of an expensive Central Data Repository (CDR).

A federated data model eliminates system integration hassles and overcomes patient identification challenges with master patient indexing logarithms. It seamlessly integrates disparate clinical and census data, transforming fragmented data into a clean and concise dashboard of information.

For example, a Clinical Portal can present admitting, attending, and referring Physicians with real-time access to all of their patients’ clinical information across multiple sites and when combined with systems such as computerized physician order entry (CPOE), provides the ability to input patient order entry and review via a web-browser. Additionally, online continuing medical education (CME), calendars, scheduling, clinical trial information, grand rounds, physician newsletters, and other relevant clinical content may all be presented in a customizable view for each user.

PHYSICIAN ACCEPTANCE
The biggest concern for busy Physicians is the time and energy required to transfer data and learn new systems. They are understandably reluctant to spend time away from patient-facing activities to address administrative business. To reduce training time, leading eHealth solution providers devote considerable resources to researching and designing intuitive applications that build on existing user experiences best practices.

Additionally, a federated data-model eliminates the need for Clinicians to learn underlying applications for checking labs or reviewing films, for example, as the GUI they use does not require any understanding of the host IT system, only to view the relevant clinical data that resides on it.

PATIENT IDENTIFICATION, PRIVACY AND HIPAA COMPLIANCE
Understandably, HCOs, Physicians and Clinicians are sensitive to their responsibility to protect confidential patient information and may see rapid, real-time online access to vital information as a threat to privacy. Understandably adequate security measures and an architectural design must be engineered to allow an organization to implement eHealth applications with demonstrable compliance with regulations and respect for the patients’ rights. Todays web 2.0 eHealth technologies including authentication protocols and CAPTCHA, encryption of secure messages, automatic audit trails of information access, controlled workflow and secure servers guard patient information from unauthorized access.

FOLLOW THE LEADERS
e-Health is certainly no longer in its infancy, yet sustained concerns about implementing new technology is understandable. It’s a real challenge for most organizations to create a tactical plan to ensure that their web capabilities support current corporate objectives.

It is far more difficult for HCOs to devise a long term plan that serves the evolving needs of the organization, adapts to technological advances, and meets new societal demands. The pressure to deliver on high-priced projects adds gravity to the matter. The initial expenses are just a small piece of the overall financial commitment an HCO makes in the transition to eHealth, and the failure rate for EHR implementations is estimated at 30 to 50 percent. False starts and implementation time-line overruns are too costly for most HCO's to risk.

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

COST AND TRAINING
In the 2006 HIMSS CIO Survey, lack of staffing resources was identified as the second most common barrier to IT adoption. Time and resource efficiencies enabled by eHealth have been demonstrated to pay for themselves in as little as a year. Fewer chart pulls and phone calls, speedier access to accurate information, lower record maintenance, and staffing costs, and revenue enhancements together create a synergy of efficiency—that more than compensates for the up-front investments.

For example, reducing the need for just one administrator/ trainer can save significant financial resources. One estimate based on a 40 hour work week over 50 weeks, and an average annual salary of $50,000, suggests that reducing one full time trainer can yield a savings of $61,000 USD a year. The architecture and design of today’s eHealth products are focused on allowing nontechnical users the maximum flexibility to manage their websites and portals. Additionally, intuitive design reduces the need for training and results in an immediate cost saving.

COMPETITIVE HOSPITALS: TRANSFORMING DELIVERY PLATFORMS
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.

However, the potential to succeed has never been clearer. A proven, cost effective model is available that delivers rapid, convenient access to any and all historical patient medical information from anywhere, regardless of when and where the care was delivered. Such a system is easily deployed, satisfies the need for cost effectiveness (ROI), dramatically increases productivity, efficiency, and makes the best use of existing resources. Ultimately, such a platform creates a healthcare environment that provides both patients and providers with improved outcomes and higher satisfaction.

Portals will allow transactions (and information) to flow rapidly and seamlessly over the web, but first the groundwork must be laid. Thankfully, proven technology exists to help healthcare organizations transition smoothly from one level of eHealth to the next at a fraction of the time and cost of competing models. Ultimately, confidence in proven solutions will embolden the willingness of responsible managers to move forward with and capitalize upon the promise of e-Health.

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How Often Do U.S. Physicians Go Online for Clinical Information?

Fifty-eight percent of U.S. physicians surveyed said they go online for clinical information at least two times per day, according to a new Epocrates survey.

Fifteen percent of physicians reported going online for clinical information once per day, while 22% reported going online for clinical information several times a week. Three percent of physicians surveyed said they go online for clinical data weekly, while 2% said they go online for clinical information monthly.

More than three out of four respondents said they go online for clinical information more often now than they did a year ago, according to the survey.

Forty-eight percent of physician respondents said they go online for clinical information most frequently during patient consultations, compared with 37% who said they most frequently look up clinical information between patient visits. Ten percent of doctors said they go online for clinical information after work, while 3% said they find clinical information online during their lunch breaks and 2% said they go online for clinical data before work.

Results are based on a survey of 501 physicians who have used the Epocrates Online product at least three times and have logged on within the past 60 days.

Source: Epocrates, "Epocrates Online Physician User Survey"
Read original article.

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.

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.

The Province of Alberta's "Netcare" EHR

The Alberta Netcare EHR is a secure lifetime record of an Albertan's key health information available for consultation by authorized health service providers. It is not a patient's full health or medical record.

Today, many physicians, pharmacists and other health service providers are recording information about their patients electronically, rather than in paper files. This information may be stored in a local electronic medical record or in a clinical information system. Labs, pharmacies, diagnostic services and community clinics are also capturing and storing information electronically.

Alberta Netcare EHR captures several key data elements from these clinical records for inclusion in a patient's provincial electronic health record. The information elements that are part of the Alberta Netcare EHR include:
• Personal demographic information that helps to uniquely identify each patient
• Prescribed dispensed drugs
• Known allergies and intolerances
• Immunizations
• Laboratory test results
• Diagnostic imaging reports
• Other medical reports

The information available for access by an Alberta Netcare EHR Portal authorized health service provider varies according to the access permissions assigned to that provider. Alberta Netcare EHR Portal also offers authorized health service providers several decision support tools including:
• Drug-to-drug and drug-to-allergy interaction alerts to avoid prescriptions that conflict
• A database of all available drugs and their common dosages
• Links to information support such as Clinical Guidelines from the Alberta Medical Association.

Contents of the EHR are maintained and updated in two ways:
• Primarily, information is automatically accessed and captured from the existing electronic data systems of pharmacies, labs, regional clinics and diagnostic services. This means that this information is not re-keyed or re-entered by anyone, it is gathered from source systems. Our partners in this process include all the health regions and the Alberta Cancer Board,
• Additionally, some information can be entered directly into a record by an Alberta Netcare authorized health service provider.

Benefits of the Alberta Netcare EHR
The Alberta Netcare EHR improves the quality and safety of care:

a) For Patients
• Providing more accurate and up-to-date medical information about a patient.
• Presenting this information immediately at the point of care which reduces delays in treatment, helps to ensure the most appropriate treatment decisions are made, and improves health outcomes.
• Reducing the possibility of medical error by improving the completeness, accuracy and clarity of medical records accessed at the point of care.
• Streamlining the secure sharing of health information between health service providers to improve the quality of patient care.
• Giving authorized health service providers a common understanding of a patient's health condition, preventing unnecessary treatments and adverse events, such as harmful prescription drug interactions.
• Reducing unnecessary duplication of tests, such as lab work.

b) For Authorized Health Service Providers
• The Alberta Netcare EHR provides access to available information at the point of care. It gives health service providers access to key patient information along with online decision support and reference tools. It also helps reduce the possibility of medical errors, assists with compliance issues, and decreases the potential for adverse drug reactions. Features like lab value trends and drug monographs also help with patient consultations.


Additional information on Alberta’s Netcare EHR.

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.