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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Sarah Kramer, President and CEO of eHealth Ontario Outlines Health Strategy

Sarah Kramer, President and CEO of eHealth Ontario spoke about the future of eHealth in Ontario at HealthAchieve 2008.

She focused on Ontario’s eHealth strategy, its system transformation goals and how the government’s goals will be implemented. In her words,the overall emphasis of eHealth in Ontario is to deliver clear, measurable, transparent results … that improve patient care quality and safety. Click here for the full text of her speech.

Background
eHealth Ontario is the marriage of the Ministry of Health and Long-Term Care’s e-Health Program and the province’s Smart Systems for Health Agency (SSHA) under one banner.

Three key e-health priorities have been identified for the next few years including a Diabetes Registry, an e-health portal to centralize health information on an easily accessible web site, and e-prescribing which will eliminate hand written prescriptions and reduce medication errors.

The ultimate goal of the e-health strategy is to create an electronic health record (EHR) for all Ontarians by 2015. An electronic health record will provide patients and providers with the ability to access, share and use health information. It will improve health care delivery, increase patient safety, reduce ER wait times and create a more effective health care system.

QUICK FACTS
* eHealth Ontario will work with the Office of the Information and Privacy Commissioner/Ontario to ensure the protection of personal health information;
* The Ontario government created SSHA in 2003 to improve patient care through a variety of initiatives, including network hosting and secure e-mail.

PROVINCE OF ONTARIO INTEGRATES ELECTRONIC HEALTH ACTIVITIES UNDER ONE AGENCY

TORONTO, Sept. 29 | McGuinty Government Appoints Dr. Alan Hudson as Chair of eHealth Ontario

The Province of Ontario has appointed Dr. Alan Hudson as the Chair of eHealth Ontario, a restructured agency responsible for all aspects of eHealth in Ontario including creating an electronic health record for all Ontarians. eHealth Ontario will bring together the Ministry of Health and Long-Term Care's eHealth program and the province's Smart Systems for Health Agency (SSHA) under one banner.

Three key eHealth priorities have been identified for the next few years including a Diabetes Registry, an eHealth Portal to centralize health information on an easily accessible web site, and ePrescribing which will eliminate hand written prescriptions and reduce medication errors.

Dr. Hudson - who is leading the government's efforts to reduce wait times in emergency rooms and for key procedures - will chair the Board of Directors for eHealth Ontario, which will have individuals from the broader health, business and information technology sectors.

"This is an exciting time for eHealth in Ontario," said Dr. Alan Hudson, Board Chair for eHealth Ontario. "Combining thought leaders from the Ministry and Long-Term Care and the broader health sector means we now have the expertise to make electronic health records a reality for the people of Ontario."

The ultimate goal of the eHealth strategy is to create an electronic health record (EHR) for all Ontarians by 2015. An electronic health record will provide patients and providers with the ability to access, share and use health information. It will improve health care delivery, increase patient safety, reduce ER wait times and create a more effective health care system.

"eHealth Ontario will enable us to transform Ontario's health care system as we know it," said David Caplan, Minister of Health and Long-Term Care. "With its broad mandate, eHealth Ontario will deliver a comprehensive, patient-focused, secure and private electronic system that will improve the way patients receive care."

QUICK FACTS
- eHealth Ontario is mandated to work with the Office of the Chief Information and Privacy Officer, Ministry of Government Services, to ensure that the protection of personal health information.

- The Ontario government created SSHA in 2003 to improve patient care through a variety of initiatives, including network hosting and secure e-mail. The agency has created the foundation for many of the eHealth activities underway today.

BACKGROUNDER
The McGuinty government named Dr. Alan Hudson, Lead of Access to Services/Wait Times with the Ministry of Health and Long-Term Care, as board chair of eHealth Ontario - a restructured agency responsible for all aspects of eHealth in Ontario including creating an electronic health record for all Ontarians.

Also named as board members are J. David Livingston, President and CEO of Infrastructure Ontario; Matthew Anderson, CEO of the Toronto Central Local Health Integration Network; Heather Sherrard, vice-president of clinical services at the University of Ottawa Heart Institute; and Ken Deane, Assistant Deputy Minister, Health System Accountability and Performance Division, Ministry of Health and Long-Term Care.

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The Emperor's New Clothes: Where EHR implementation meets parody

In the original Hans Christian Andersen tale, an emperor unwittingly hires two swindlers to create a new suit of clothes for him. The two swindlers promise him the finest suit of clothes from the most beautiful cloth. This cloth, they tell him, is invisible to anyone who was either stupid or unfit for his position. The Emperor cannot see the (non-existent) cloth, but pretends that he can for fear of appearing stupid; his ministers do the same.

In our Canadian reality, the “finest suit of clothes” being promised is apparently the current state of a Provincial and National Electronic Health Record (EHR.) The metaphorical 'Emperor' can pretend whatever they like, as can his ministers, however — the lack of a “suit of clothes” or in our case, the lack of any real, measurable progress in extending an EHR needs to be addressed and parties held accountable. When the small child cries out, "But he has nothing on" and the crowd realizes the child is telling the truth and begin laughing—--it’s likely time to make some changes. As evidence of the satirical (vendor-driven) state of Electronic Health Records today---I give you http://seedie.org.

SEEDIE, the Society for Exorbitantly Expensive and Difficult to Implement EHR’s, is a healthcare IT standards organization that is completely funded and operated by a select group of proprietary electronic health record vendors.

Unlike independent, objective, professional organizations created to help medical professionals select and implement interoperable EHR solutions, SEEDIE promotes healthcare IT systems that play well in the sandbox if, and only if, it is in the best interests of a particular vendor. While the other groups argue endlessly about which standards are most appropriate in pursuit of “plug and play” solutions, SEEDIE recognizes that data exchange should only occur after a lengthy and expensive custom integration process. Further, that integration should require ongoing technical support from multiple vendors.

Smart Systems for Health Agency (SSHA) responds to EHR criticism

Smart Systems for Health Agency (SSHA) has hit back at criticism from Ontario's Information Privacy Commissioner Ann Cavoukian on the progress made so far in the development of an Ontario-wide EHR.
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