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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Google Health opens, sparks privacy woes

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

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

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

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

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

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

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

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

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

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

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



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

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

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

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

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

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

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

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

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

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

INDUSTRY LEADERS FORM TASK FORCE TO ALIGN ON ELECTRONIC HEALTH RECORD STANDARDS

May 1, 2008 - Focused on the acceleration of electronic health records, industry leaders from Canada Health Infoway (Infoway), Canadian Healthcare Information Technology Trade Association (CHITTA, the Health Division of Information Technology Association of Canada (ITAC)), and the Association of Health Technology Industry (AITS) announced today they have formed a task force to accelerate and promote the transition to a new set of pan-Canadian health information technology standards.

The task force will collaboratively work to promote the adoption of pan-Canadian standards, especially with point of service systems, by engaging clinicians, health care providers and vendors. Involving these stakeholders will support the planning required to ensure the interoperable electronic health record (iEHR) is leveraged and the adoption of pan-Canadian standards is accelerated.

"Time and again, we have seen the success of industries like the financial and consumer sectors drive faster end-user adoption through the implementation of standards," said Dennis Giokas, Chief Technology Officer, Canada Health Infoway. "With the aligned direction of our industry partners we can now work collaboratively to accelerate the deployment and use of these interoperability standards for the benefit of Canadians and the Canadian health care system."

Common standards are an integral element of, and a key requirement for, the establishment of a pan-Canadian interoperable electronic health record. Significant cost savings and quality improvements are achieved when custom integration is eliminated. Patients, clinicians and health service delivery organizations all benefit when data can be reliably shared across health care systems.

"We have been building health care systems using industry standards for over 20 years. Achieving full adoption of the pan-Canadian standards, and realizing the benefit of Canada's health infrastructure investments, is a multi-year journey until new products emerge and legacy systems are retired," said Brendan Seaton, President, CHITTA, the Health Division of Information Technology Association of Canada (ITAC).

"Health information systems tend to be stable, so we will see a period where both existing and new standards are supported. We look forward to collaborating with health providers and Canada Health Infoway on developing solutions for this transition."

To enable the successful deployment of interoperable electronic health record solutions, the organizations support the use of: HL7 and DICOM for messaging, LOINC® and SNOMED CT® for terminologies, HL7's Clinical Document Architecture (CDA) for documents, HL7's Clinical Context Object Workgroup (CCOW) specification for clinical context management, as well as the pan-Canadian interoperability profiles.

"The transition to common, pan-Canadian standards allows us to achieve the highest quality in an interoperable electronic health record system. As an industry we are starting to see market demand for these new standards, and our members are making commitments to meet that demand. Success will come when we work together on this very complex challenge," said Daniel Laplante, Executive Director, AITS. Canada is a strong contributor to the global acceleration of EHR standards through its unique collaboration model.

Launched in 2006, the Standards Collaborative provides coordination, implementation, support, education, conformance and maintenance of electronic health record standards in Canada. One third of its members are representatives from health information technology companies.

Read Original Article.

About Infoway
Infoway is an independent, not-for-profit organization funded by the Federal government. Infoway jointly invests with every province and territory to accelerate the development and adoption of electronic health record projects in Canada. Fully respecting patient confidentiality, these secure systems will provide clinicians and patients with the information they need to better support safe care decisions and manage their own health. Accessing this vital information quickly will help foster a more modern and sustainable health care system for all Canadians.

About CHITTA
CHITTA, the Canadian Health Information Technology Trade Association, is the Health Division of ITAC, the Information Technology Association of Canada. CHITTA represents more than 120 companies across Canada that provide information and communications technology (ICT) products and services to the health sector. CHITTA represents the Industry to governments and health care decision-makers for the purposes of building a strong and sustainable health ICT industry in Canada, promoting investment in health ICT, and ensuring the interoperability of health ICT systems.

About AITS
Created in 1987 and representing over 100 members, the Association of health technologies industry's (AITS) mission is to stimulate the development of the health technologies industry and to promote its economic and social value. AITS is a meeting place for exchanges between partners on domestic and foreign markets.

Empowering consumers with their health records: Canada to take a close look at PHR’s

TORONTO, April 17 /CNW/ - As the Internet has enabled consumers to manage important aspects of their personal lives from the relative comfort of their home, it is no surprise that Canadians are becoming increasingly intrigued by the prospect of being able to view and manage their health information using emerging personal health records (PHR) technologies.

Recent announcements by major players in the IT industry suggest such capabilities are just around the corner. Recognizing developments in this area are moving quickly, Canada's federal, provincial and territorial health ministries have expressed support for Canada Health Infoway's (Infoway) plan to discuss personal health record solutions with interested vendors and to explore how these technologies could be made available to Canadians in a secure manner.

"Providing Canadians and their health care providers with appropriate and secure access to their health information has been our goal from the onset," said Richard Alvarez, President and CEO of Canada Health Infoway, the federally-funded, independent, not-for-profit organization that is leading the adoption of electronic health records across Canada. "The prospect of seeing consumer health solutions in the Canadian marketplace is an exciting development indeed. It is also critical that we ensure these offerings provide the appropriate level of trust, protecting the privacy and security of Canadians' health information."

"The Government of Canada, through its funding of Infoway, is investing in the national transition from paper to electronic health records," said the Honourable Tony Clement, Federal Minister of Health. "I am pleased that personal health record solutions will complement and leverage our investments to date in e-health solutions. With the appropriate ground work in place, PHR's will ultimately deliver greater value to Canadian patients."

"Canadians are taking increasingly active roles in managing their chronic diseases and preventing illness from setting in," said Chris d'Entremont, Minister of Health for Nova Scotia, who serves as the liaison minister between Infoway and federal, provincial and territorial health ministers. "Our investments in the implementation of electronic health records are crucial to our goal of ensuring Canadians have access to the information and tools they need to manage their care. The onset of personal health record solutions can accelerate our desire to enable patients to have these capabilities."

A number of technology vendors have expressed interest in creating solutions that will equip Canadians with the technology they need to view their medical data. Working with Infoway and its partners will help ensure the solutions available to Canadians will leverage the progress made in implementing electronic health record projects across Canada. Using technology solutions that are compatible with Infoway's blueprint will ensure patient privacy and security provisions are adhered to. Infoway has funded 249 electronic health record projects across Canada to date. These secure systems are leading the pan-Canadian switch from inefficient paper-based storage of medical data such as lab test results,prescription history and allergy information to electronic systems that are far more efficient, save money, and save lives.

Canada Health Infoway is an independent, not-for-profit organization funded by the Federal government. Infoway jointly invests with every province and territory to accelerate the development and adoption of electronic health record projects in Canada. Fully respecting patient confidentiality, these secure systems will provide clinicians and patients with the information they need to better support safe care decisions and manage their own health. Accessing this vital information quickly will help foster a more modern and sustainable health care system for all Canadians.

For further information: Dan Strasbourg, Director, Corporate
Communications, Canada Health Infoway, dstrasbourg@infoway-inforoute.ca, (416)
595-3424

Lessons from our neighbor to the north

The U.S. is facing a crisis with the quality, disparity and cost of our health care services. We operate a fragmented health care delivery system marked by silos of data.

Creating a cohesive health care system is exactly what we need in order to deliver high-quality, cost-effective, and timely patient care. Luckily, we have a model to follow directly to our north in Canada.

Canada’s 14 federal, provincial and territorial deputy ministers of health - as well as regional health care authorities, other health care organizations and its information technology vendors and suppliers – are working together toward a common goal: to provide 50 percent of Canadians access to a secure electronic health record by 2010.

How does a country with more than 33 million people come to an agreement and move forward with a country-wide health care IT system? Easy – in Canada, the health care IT infrastructure functions like a business unit. To move forward with EHR adoption, this group did research, made a decision, secured funding, and began implementation.

In the U.S. we don’t make decisions nearly this quickly. We’ve been churning over patient identification, for example, for more than a decade. Churn costs money; churn costs development time and effectiveness; ultimately, churn costs lives. Let’s take a lesson from our northern neighbors and get the job done.

Spearheading Canada’s initiative is Canada Health Infoway, Inc., an independent not-for-profit organization that invests with public partners across Canada to implement and reuse compatible health information systems.

One of the first steps in mounting this nationwide project – and one of the most pivotal aspects of its success – was to create a common blueprint, or electronic health record “infostructure.”

This blueprint includes:

-- Client registry systems, similar to enterprise master person indexes and record locator services that support health information exchanges in U.S. domain repositories.

-- A longitudinal record service, to coordinate data across multiple domains and registries

-- Standardized services and communications to ensure privacy, security and interoperability

-- Standardized information and message structures to support inter-infostructure information exchange

In this model, each infostructure interoperates with others in a peer-to-peer manner through the Health Information Access Layer (HIAL), where the data-sharing journey begins and ends.

Let’s learn from Canada’s success and follow a business-model approach.

First, of course, let’s have a blueprint. Second, let’s invest wisely and strategically – and measure results to monitor that investment. The Canadian government invested $1.6 billion in its initiative. The government entities knew they needed to see value from their investment, so they funded a small number of targeted areas rather than spreading their investment across a range of initiatives.

The Canadian government also demands results. Each year, Infoway is accountable for reporting status and success metrics. Again, this mirrors the way a business unit would operate.

Third, no churning. Period. Let’s make decisions and start to move.

Ron G. Parker, Infoway’s director of architecture, added this advice: “It is important to invest in a structured collaboration model that ensures all key stakeholder communities are represented in the process of standardization.”

Standardizing business processes in any industry requires a three-level “sell," he says: to the executive decision makers, to the people with industry domain expertise, and to the people that build the business processes. “Only if everybody in this ‘stack’ knows the other groups are good-to-go, can you have success,” he says.

I love Canada. I just don’t want to move there. In fact, I’d like to retire in Montana. My hope is that we’ve got a nationwide health care IT system in place by that time. Needless to say, the clock is ticking. Can’t we follow someone else’s lead?

Original Article By Lorraine Fernandes. Fernandes is a vice president and health care industry ambassador for Initiate Systems, Inc.

B.C. upgrades PharmaNet to advance electronic health care

Victoria, B.C., March 10, 2008 - B.C. is enhancing PharmaNet as the next step in implementing electronic health records by investing $14.2 million in its eDrug project, Health Minister George Abbott announced today.

"Upgrading PharmaNet will help us further improve patient safety and better protect patients from medication errors that occur in a paper-based system," said Abbott. "With the new PharmaNet, physicians and pharmacists will be able to track patient medications between acute care and community settings and provide greater accuracy in the PharmaNet medication profiles."

PharmaNet is internationally recognized as a world-class secure electronic network that protects patient safety. It protects patients from potentially dangerous medication errors, duplications and dangerous combinations of different medications. It records all prescriptions dispensed at B.C. community pharmacies in a central database and checks for interactions.

eDrug is one of seven eHealth projects underway in British Columbia that will use advanced information technology to deliver needed health information instantly to authorized health professionals in B.C. The eDrug project, in addition to delivering the new PharmaNet-eRx system, will:

Provide online tools so physicians and pharmacists can offer affordable, best-practice therapies;
• Provide greater accuracy in the PharmaNet medication profiles by recording both dispensing by the pharmacists, and pickup of the prescription by the patient;
• Reduce administrative time in submitting PharmaCare Special Authority requests;
• Strengthen the privacy and security features of PharmaNet; and
• Over time, enable physicians to prescribe online.

"Pharmacists welcome upgrades to PharmaNet that will improve patient care," said Marshall Moleschi, Registrar of the College of Pharmacists of BC. "Updating PharmaNet has the potential to improve patient safety by reducing adverse drug events, avoid treatment delays and call backs leading to more effective and efficient care delivery."

Funding for B.C.'s eDrug program comes from the Province and Canada Health Infoway, a federally-funded, not-for-profit organization that is leading the development and adoption of electronic health records across Canada. Infoway is contributing $8.8 million and the Province is contributing $5.4 million of the $14.2 million agreement.

"PharmaNet has been one of Canada's leading e-health initiatives for more than a decade," said Richard Alvarez, president and CEO of Canada Health Infoway. "By connecting physicians and pharmacists, the new PharmaNet-eRx system will help reduce medication-related adverse events, increase patient safety and result in better health outcomes for patients throughout British Columbia."

Currently MAXIMUS BC and Systems Xcellence Inc. (SXC) maintain PharmaNet for the Ministry of Health's Pharmaceutical Services Division. The enhancements to PharmaNet are in a Change Order to the existing Master Services Agreement for an additional $14.2 million. The Change Order will see MAXIMUS BC configure and install a new SXC application as well as integration of this product with other eHealth components.

"This is major improvement to the already world-class PharmaNet system," said MAXIMUS BC president Duff Lang. "Improving information access for pharmacists and the public will truly deliver on the eHealth vision and will enable us to continue our quality service on behalf of the province."

All patient information will be protected by privacy measures that are among the strongest in Canada. The personal health information in PharmaNet and other components of a new electronic health record will comply with applicable privacy protective legislation, including the Province's Freedom of Information and Protection of Privacy Act, the Personal Information Privacy Act, the Pharmacists, Pharmacy Operations and Drug Scheduling Act and provisions of the Health Act that govern the use of information for health-related purposes. In addition, access to patient information will be restricted to only those having legal authority and a clear need to access the information.

Canada Health Infoway is leading the development and implementation of electronic health projects across Canada. Infoway works with provinces and territories to invest in electronic health projects, which support safer, more efficient health care delivery. Fully respecting patient confidentiality, these private and secure systems provide health care professionals with immediate access to complete and accurate patient information, enabling better decisions about diagnosis and treatment. The result is a sustainable health care system offering improved quality, accessibility, productivity and cost savings.

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Nova Scotia embarks on province-wide EHR

HALIFAX – Contracts for major components of Nova Scotia’s electronic health record system were announced earlier this month by provincial Health Minister Chris d’Entremont.

The components include a secure health record storage and viewing system for patient information, which doctors and other healthcare workers can access when and where they need to. A client and provider registry will also be created to identify patients and healthcare providers, and to link medical records from multiple systems.

“These elements are foundational pieces for Nova Scotia’s electronic health record system,” said Mr. d’Entremont. “Healthcare professionals will be able to quickly access patients’ health records regardless of where in the province they are being cared for, whether it’s in an ER in Shelburne, or a specialist’s office in Sydney. The result will be better care, faster treatment and improved access to information.”

The province’s electronic health record system, called SHARE (Secure Health Access Record), will create an electronic health record for all Nova Scotians. The record will contain patients’ up-to-date health information to support decision-making and case management by healthcare providers.

The first phase of the SHARE system will be completed by Dec. 31, 2009 and will cost $28 million. Nova Scotia has partnered with Canada Health Infoway, which is contributing $17.8 million. The first phase will include patient information from the province’s three lab systems, the diagnostic imaging system and clinical records from provincial hospitals.

“Nova Scotia is making a significant leap towards providing every resident with an electronic health record,” said Richard Alvarez, President and CEO of Canada Health Infoway, the federally-funded, independent not-for-profit organization which invests with public sector partners to accelerate adoption of electronic health records across Canada.

“Having been one of the first provinces to go completely digital with X-ray images, Nova Scotia patients and clinicians have seen first-hand the benefits associated with this evolution. Today’s announcement is about keeping Nova Scotia at the forefront of electronic health record implementation in Canada.”

The Department of Health has signed agreements with Initiate Systems for its client and provider registry software, implementation services and training ($3.2 million), and McKesson Canada for its Horizon Physician Portal for the viewer and Horizon Care Record for the clinical repository for secure health record storage ($2.4 million).

A third contract has been awarded to a local consortium led by Sierra Systems, including xwave and the Barrington Consulting Group, to set up a project management office to oversee system integration ($5.3 million over two years).

Canada Health Infoway is leading the development and implementation of electronic health projects across Canada. Infoway works with provinces and territories to invest in electronic health projects, which support safer, more efficient healthcare delivery. Fully respecting patient confidentiality, these private and secure systems provide healthcare professionals with immediate access to complete and accurate patient information, enabling better decisions about diagnosis and treatment. The result is a sustainable healthcare system offering improved quality, accessibility, productivity and cost savings.

View the original article in Canadian Healthcare Technology Magazine.

Google to store patients' health records

Google Inc. will begin storing the medical records of a few thousand people as it tests a long-awaited health service that's likely to raise more concerns about the volume of sensitive information entrusted to the internet search leader. The pilot project to be announced Thursday will involve 1,500 to 10,000 patients at the Cleveland Clinic who volunteered to an electronic transfer of their personal health records so they can be retrieved through Google's new service, which won't be open to the general public.

Each health profile, including information about prescriptions, allergies and medical histories, will be protected by a password that's also required to use other Google services such as e-mail and personalized search tools. Google views its expansion into health records management as a logical extension because its search engine already processes millions of requests from people trying to find more information about an injury, illness or recommended treatment.

But the health venture also will provide more fodder for privacy watchdogs who believe Google already knows too much about the interests and habits of its users as its computers log their search requests and store their e-mail discussions.

Prodded by the criticism, Google last year introduced a new system that purges people's search records after 18 months. In a show of its privacy commitment, Google also successfully rebuffed the U.S. Justice Department's demand to examine millions of its users' search requests in a court battle two years ago.

Pilot project has uncertain timetableThe Mountain View-based company hasn't specified a timetable for unveiling the health service, which has been the source of much speculation for the past two years. Marissa Mayer, the Google executive overseeing the health project, has previously said the service would debut in 2008.

Contacted Wednesday, a Google spokesman declined to elaborate on its plans. The Associated Press learned about the pilot project from the Cleveland Clinic, a not-for-profit medical cente founded 87 years ago. The clinic already keeps the personal health records of more than 120,000 patients on its own online service called MyChart. Patients who transfer the information to Google would still be able to get the data quickly even if they were no longer being treated by the Cleveland Clinic.

"We believe patients should be able to easily access and manage their own health information," Mayer said in a statement supplied by the Cleveland Clinic. The Cleveland Clinic decided to work with Google "to create a more efficient and effective national health care system," said C. Martin Harris, the medical centre's chief information officer.

Google isn't the first high-tech heavyweight to set up an online filing cabinet in an effort to make it easier for people to get their medical records after they change doctors or health insurance plans.

Health services go online
Rival Microsoft Corp. last year introduced a similar service called HealthVault, and AOL co-founder Steve Case is backing Revolution Health, which also offers online tools for managing personal health histories.

The third-party services are troublesome because they aren't covered by the Health Insurance Portability and Accountability Act, or HIPPA, said Pam Dixon, executive director of the World Privacy Forum, which just issued a cautionary report on the topic.

Passed in 1996, HIPPA established strict standards that classify medical information as a privileged communication between a doctor and patient. Among other things, the law requires a doctor to notify a patient when subpoenaed for a medical record. That means a patient who agrees to transfer medical records to an external health service run by Google or Microsoft could be unwittingly making it easier for the government or some other legal adversary to obtain the information, Dixon said. If the medical records aren't protected by HIPPA, the information conceivably also could be used for marketing purposes.

Google, which runs the internet's most lucrative ad network, typically bases its marketing messages on search requests and the content on web pages and e-mail contained in its computers. It's not clear how Google intends to make money from its health service. The company sometimes introduces new products without ads just to give people more reason to visit its website, betting the increased traffic will boost its profits in the long run.

View Original CBC News Article © The Canadian Press, 2008

HIMSS 2008 | Orlando 24th-28th, 2008

Updated News & Announcements

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

The Brampton Guardian | Monday December 24 2007 | PETER CRISCIONE

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

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

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

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

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

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

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

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[Original Article]

Canada Health Infoway negotiates preferred solution agreement with electronic health record (EHR) viewer provider

Toronto, January 10, 2008 - Canada Health Infoway (Infoway) today announced it has negotiated preferential conditions and pricing with Orion Health through a Preferred Solution Agreement for their Concerto Physician Portal, an EHR viewer.

EHR viewers are secure web-based applications that integrate patient information from various sources into a single record, unique to each patient.

"We are making great progress towards the modernization of Canadian patients' health information and that means more and more clinical data is being captured and stored electronically," said Richard Alvarez, President and CEO of Canada Health Infoway, the federally-funded, independent not-for-profit organization which invests with public sector partners to accelerate electronic health records across Canada. "The EHR viewer is a vital tool for clinicians because it is the electronic gateway to the information clinicians rely on to make appropriate care decisions for their patients."

The Canada-wide agreement will help accelerate the implementation of electronic health records, making it simpler for provinces and territories to acquire a health record viewer solution.

An EHR viewer eliminates the need for health care practitioners to learn multiple computer interfaces and improves accuracy by bringing information from across numerous systems into one familiar screen that is customizable for each user's requirement. These systems have many benefits when implemented in a standards-based environment.

Infoway's Preferred Solution Agreements show that participating vendors like Orion have a deep understanding of the pan-Canadian EHR and the need to adopt established standards to ensure interoperability. While Infoway believes that these agreements offer significant value, the selection of specific vendors rests with the individual province or territory.

[Original Article]

About Canada Health Infoway
Infoway is an independent not-for-profit organization that invests with public sector partners across Canada to implement and reuse compatible health information systems which support a safer, more efficient healthcare system. Fully respecting patient confidentiality, these private and secure systems provide healthcare professionals with rapid access to complete and accurate patient information, enabling better decisions about diagnosis and treatment. The result is a sustainable, health care system offering improved quality, accessibility and productivity.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

[Original article]

A Closer View of E-health

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

IT Executives Tout Technology To Transform U.S. Health Care

Representatives of three major IT firms said that consumer technologies could transform U.S. health care and its delivery, Government Health IT reports. The IT executives spoke at a National Cancer Institute-sponsored symposium, called "The Future: Consumer Health Information Technology."

Adam Bosworth, former director of Google Health, said failure to leverage IT has hampered the dissemination of medical research, stunted the growth of evidence-based medicine and focused doctors on sickness rather than keeping patients healthy.

He added that IT could have an immediate impact if the health care model was altered to give patients ownership of their medical data and allow researchers to more easily test new protocols.

Bill Crounse, Microsoft's worldwide health director, said that among advanced nations, the use of health IT in the U.S. ranks among the "worst of the worst."

The United Kingdom spends 10 times as much as the U.S. on health IT, according to Bradford Hesse, chief of the Health Communication and Informatics Research Branch at the National Cancer Institute.

Bern Shen, chief health care strategist at Intel Digital Health, predicted that technology-enabled health care could move from hospitals and medical centers to the home similar to how computing evolved from mainframes to personal computers.

All the panelists agreed that the Internet in recent years has empowered health care users (Pulley, Government Health IT, 12/11).

IT Could Cut Canada's Health Care Costs by About $7B Annually

November 13, 2007 | Creation of Canadian electronic health records (EHR) system could save billions in costs annually. President of Canada Health Infoway predicts huge reduction in need for diagnostic tests, fewer days in hospital.

Richard Alvarez, President of Canada Health Infoway, the country's planned health information sharing program -- said that more effective information management through the use of IT could reduce national health care costs by $6 billion to $7 billion Canadian, or about $6.24 billion to $7.29 billion, annually, Charlottetown Guardian reports.

The savings would come from reducing hospitalizations based on unnecessary drug interactions and a reduction in duplicate diagnostic tests, the Guardian reports.

The Canadian federal government plans to invest $1.6 billion Canadian, or about $1.66 billion, into Health Infoway and leverage another $1.6 billion Canadian, or about $1.66 billion, from provincial and territorial governments.

"This is a $10 billion (Canadian) project all told by the time it is completed and we expect that to happen over the next 10 years," Alvarez said.

Alvarez said the nationwide health IT program will "start with hospitals, then pharmacies and community clinics, and probably the last to come on board will be family doctors' offices" (Original article from Charlottetown Guardian, 11/13).

U.S. Poll: Most Adults Say EHR Benefits Outweigh Privacy Risks

Nearly two-thirds of U.S. adults believe that the benefits of electronic health records outweigh the privacy risks, according to a new Wall Street Journal Online/Harris Interactive poll, the Wall Street Journal reports.

Three-quarters of the survey's 2,153 respondents said they agree that patients would receive better care if doctors and researchers were able to share information more easily through electronic systems. Similarly, 63% said that using EHRs could reduce medical errors, and 55% said EHR sharing could reduce health care costs. However, about 25% of respondents said they are unsure if EHRs can provide these benefits.

The survey, which was conducted between Nov. 12 and 14, also found that about 25% of respondents said they currently use some form of EHR. Of those, 23% said the EHR is maintained by their physician, while 2% said they created and maintain their own personal health record on their computer. Fifty-six percent of respondents said they do not have an EHR, while 17% said they are unsure if they have an EHR.

The poll indicates that privacy concerns still remain among health care consumers. Half of those surveyed said EHRs make patient privacy more difficult to ensure, down from 61% in 2006. Twenty-five percent of those surveyed said EHRs would not make it more difficult to ensure patients' privacy, while another 25% said they were unsure.

November 29, 2007 from iHealthbeat

eHealth Leaders | Mississauga Hospitals sharing patient records

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Rebooting Canadian Healthcare using eHealth Portals

by Dan Germain, VP, Chief Financial and Information Officer, The Credit Valley Hospital as published in Canadian Healthcare Technology Magazine | Vol.12, No. 8 | Nov/Dec 2007.

According to recent statistics from the Canadian Institute for Health Information, as many as 24,000 Canadians die each year from adverse events like surgical errors, patients receiving the wrong medication, and hospital-acquired infections. As the practice of medicine today is inherently dependent upon healthcare technology, the accountability and sustainability of our healthcare system depends on the ability of healthcare practitioners to find ways of gaining efficiencies and increasing effectiveness in every aspect of their daily activities.

All levels of government across Canada are experiencing pressures today to cut healthcare delivery costs, while increasing the level patient safety and care. With this demand for managed care, technology is quickly evolving to meet new and more complex requirements, with significant benefits to medicine and healthcare overall. As Charles Darwin so aptly identified: “It is not the strongest of the species that survive, nor the most intelligent, but the one most responsive to change.” In the past, the acquisition of technology was viewed as the answer in and of itself. Decisions about technology and usage were typically driven by the question of how to improve the effectiveness of what hospitals were already doing. However, today’s information systems should be viewed as a vehicle to transform current hospital processes into what they could and should be doing.

At the same time, there is a demonstrated understanding for the need to update technology systems in order to extend a national electronic health record (EHR) in Canada. Healthcare stakeholders agree that technology is critical to facilitating necessary information-sharing across disciplines and venues. Driven by Canadian Health Infoway, this movement embraces the need to evolve healthcare informatics toward a more open, standards-based, patient-centric model that brings together all imperatives: clinical, administrative, financial, managerial, and human resources.

With the information-sharing capabilities provided today by a rapidly expanding number of new technologies, Canadian healthcare organizations can leverage a crucial tool-set to support informed medical decisions at the point of care. To this end, healthcare providers and vendors both agree that a consistent, standardized way to share information between healthcare stakeholders can overcome the barriers to attaining an EHR.

One destination; Many paths
When any healthcare organization sets out to extend a ‘cradle-to-the-grave’ EHR – readily accessible via the Internet and linked to clinical protocols and guidelines — most people picture only one scenario. In this scenario, a user enters a patient query into one computer system, and that query goes to one source where all the patient information has been stored in a single “centralized” database, or vertical architecture. The system searches one database and returns the queried information to the user. The problem with this scenario, is that information is not best accessed in this manner as the required patient data resides somewhere in a disparate system.

However, this is not the only option. Instead of duplicating that patient data in a new centralized system, the healthcare organization could leave the existing data in place. Then, when the user enters a query about a patient, the system logically gathers the appropriate patient data from wherever it is stored. This approach is called a “federated” database model and employs a horizontal architecture. Anyone who uses the Internet takes the delivery of content from multiple systems for granted. Almost every Web page is automatically assembled from multiple sources, and employs a federated database model. One simply clicks a button and data is retrieved from disparate databases and servers.

By definition, a federated database is a collection of data stored on multiple autonomous computing systems connected by a network that is intuitively presented to users as one integrated database. Additionally, using a federated portal approach allows bandwidth, hardware, administration, and other infrastructure costs to be distributed over time, keeping pace with the development and deployment of the facility. This can significantly reduce networking and system-interfacing costs and opens up a number of added functional possibilities by extending data to the organization’s value chain delivering clear, tangible benefits for your short and long term needs. Compared to a centralized portal, today’s federated architecture can achieve equivalent or better results, at a fraction of the cost and time.

Follow the leaders
The Credit Valley Hospital (www.cvh.on.ca) is a vibrant community hospital providing leadership in the delivery of primary, secondary, and tertiary health care services to the people of Mississauga, Ontario and the surrounding LHIN-6 region. Serving more than 5,400 visitors daily, The Credit Valley Hospital (CVH) has provided patients with access to cutting-edge medical research, programs and treatment since 1985, recently opened a new Ambulatory Care Wing that offers both systemic (chemotherapy) as well as radiation therapy as a regional Cancer Centre. By 2011, CVH will have completed another expansion adding 145 new inpatient beds to the community. . As such, it’s not surprisingly to imagine that the 2,700 staff and nearly 400 physicians generate and store a significant amount of disparate data.

CVH recently implemented a MEDSEEK Web solution which facilitates various healthcare organizations to support vendor-neutral and enterprise-wide system interoperability. Due to the regional programs at CVH, it was critical that all departments were able to share data amongst its providers. The goal was to be able to provide the same information sharing capabilities among various healthcare facilities, nation-wide, as well as reduce redundancies like test duplications due to missing or unavailable information. After implementing the federated portal, CVH saw an immediate improvement in both patient flow and medical care throughout the hospital. Today, patient-data is immediately available from any computer with Internet access, whether the disparate data actually resides at the two sites (Etobicoke and Brampton) of William Osler Health Centre (www.williamoslerhc.on.ca) or at the three sites (Oakville, Milton, Georgetown) of Halton Healthcare (www.haltonhealthcare.com). The population served by these portals exceeds one million people residing in Mississauga, Brampton, Halton Hills, and Oakville.

Agfa Healthcare’s Clinical Dashboard™ (powered by MEDSEEK) is the only proven federated portal model in the country that addressed CVH’s unique pain points in an efficient and cost-effective manner. The portal met the organizations rigorous selection criteria by offering superior software and services, clinical integration experience, and the ability to expand to future enterprise eHealth solutions. The combination of ease of use, real-time data access and enhanced clinical functionality enhances patient care and clinical excellence, while extending a virtual EHR. In addition, the solution was implemented in only 90 days – at a fraction of the cost for a centralized portal solution – which was vital.

Jeff Lamb, Executive Vice President of Sales at MEDSEEK confirms those sentiments: Enhanced integration functionality throughout a medical enterprise yields immediate operational efficiencies including reduced paperwork, improved communications, better workflow management, and stronger relationships among clinicians, patients and the community. For CVH specifically, having connectivity to William Osler and Halton Healthcare facilities, the portal provides a virtual medical record of all patient data across multiple LHINs. This not only improves physician efficiencies but also contributes to enhanced patient safety and care.

The federated portal solution evolves Canada’s healthcare delivery toward a more open, standards-based, patient-centric model, at a fraction of the time and cost of the centralized portal approach. CVH expects this solution to significantly reduce surgical and medication errors while making lives easier for staff. Additionally, as CVH expands its portal solution to support PDAs, the portal will become even more valuable as patients will be able to ask their physician specific questions and have results available immediately. Ultimately, however, the biggest winner is the Canadian patient and taxpayer.

There’s no argument about the need for a better way to access information, reduce medical errors and increase the quality of patient care, and that technology plays a critical role in making this happen. However, using technology the way it’s always been used is not the best approach for the kind of radical change needed. Through examples like CVH, it’s clear that interconnectivity and information-sharing between hospitals, LHINs, and even across provinces is a reality, and can significantly benefit from a new, “federated” way of thinking.