The 2008 ACUMEME eHEALTH AWARD

The ACUMEME e-HEALTH AWARD is given to Canadian Healthcare delivery organization that has successfully extended e-Health application(s) that further our national objective of a comprehensive, interoperable, and transferrable electronic health record (EHR.) The Award promotes and recognizes the exchange of best practices within the field of e-Health.

ACUMEME is pleased to announce the 2008 e-HEALTH AWARD WINNER is the Rapid Electronic Access to Clinical Health Information (REACH) EHR Viewer Initiative in the Province of Ontario’s Local Health Integration Network’s 5 and 6 respectively. Constituent Hospitals include the Credit Valley Hospital, Halton Healthcare Services, and William Osler Health, Headwaters Health, and Trillium Health Centre.

REACH is shaping the future of patient care in Canada. As the first Integrated LHIN’s, REACH extends a seamless (“read-only”) connection to critical patient information aggregated from multiple vendors and multiple sites. For over 1.8 million Canadians residing in LHIN’s 5&6 this ensures their historical patient data is available along the entire continuum of care---regardless of geographical location. Utilizing state of the art clinical portal technology (provided by vendor MEDSEEK,) the REACH platform intuitively weaves together all existing clinical data and services from 11 Hospital sites into one intuitive, unified, patient-centric view at the point of care. When Physicians, hospitals, labs, pharmacies, clinicians, consumers, and researchers are connected through integrated IT systems—healthcare delivery is safer, more efficient, and value-driven.

REACH promises to have a significant effect on patient safety and wasteful duplication, while extending Canadian’s a regional care system where privacy, security, and confidentiality are respected and easily moderated. Congratulations to REACH (and its member constituents) for winning ACUMEME’s 2008 e-HEALTH AWARD.

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Additional information on the REACH EHR Initiative.

Most US Doctors Aren’t Using Electronic Health Records

June 19, 2008 | By STEVE LOHR

A US government-sponsored survey of the use of computerized patient records by doctors points to two seemingly contradictory conclusions, and a health care system at odds with itself.

The report, published online on Wednesday in The New England Journal of Medicine, found that doctors who use electronic health records say overwhelmingly that such records have helped improve the quality and timeliness of care. Yet fewer than one in five of the nation’s doctors has started using such records.

Bringing patient records into the computer age, experts say, is crucial to improving care, reducing errors and containing costs in the American health care system. The slow adoption of the technology is mainly economic. Most doctors in private practice, especially those in small practices, lack the financial incentive to invest in computerized records.

The national survey found that electronic records were used in less than 9 percent of small offices with one to three doctors, where nearly half of the country’s doctors practice medicine.

Dr. Paul Feldan, one of three doctors in a primary care practice in Mount Laurel, N.J., considered investing in electronic health records, and decided against it. The initial cost of upgrading the office’s personal computers, buying new software and obtaining technical support to make the shift would be $15,000 to $20,000 a doctor, he estimated. Then, during the time-consuming conversion from paper to computer records, the practice would be able to see far fewer patients, perhaps doubling the cost.

“Certainly, the idea of electronic records is terrific,” Dr. Feldan said. “But if we don’t see patients, we don’t get paid. The economics of it just seem so daunting.” Private and government insurers and hospitals can save money as a result of less paper handling, lower administration expenses and fewer unnecessary lab tests when they are connected to electronic health records in doctors’ offices. Still, it is mainly doctors who bear the burden making the initial investment.

“We have a broken market for electronic health record adoption because the people who gain financially are not the people who pay,” said Dr. Blackford Middleton, a health technology expert at Partners Healthcare, a nonprofit medical group that includes Massachusetts General Hospital in Boston.

To fix the market, Dr. Middleton, like others, recommends that the government play a role in providing incentives or subsidies to speed the use of computerized patient records in the United States, whose adoption rate trails most developed nations. The government took a step in that direction last week, announcing a $150 million Medicare project that will offer doctors incentives to move from paper to electronic patient records. The program is intended to help up to 1,200 small practices in 12 cities and states make the conversion.

Individual doctors will be offered up to $58,000 over the five-year span of the project, which is intended to test the impact of incentives on the spread of electronic health records. Further programs across the country are planned. The report published in the journal also found that electronic health records were used by 51 percent of larger practices, with 50 or more doctors. Indeed, electronic health records are pervasive in the largest integrated medical groups like Kaiser Permanente, the Mayo Clinic, the Cleveland Clinic, University of Pittsburgh Medical Center and others. These integrated groups not only have deep pockets. By combining doctors, clinics, hospitals and often some insurance they can also capture the financial savings from electronic health records.

The findings of the study, which was paid for by the Department of Health and Human Services and a grant from the Robert Wood Johnson Foundation, broadly echo previous research on the adoption of electronic health records. Large medical groups have long been the early adopters, and small practices have struggled.

But the new study is based on a large sampling — more than 2,600 doctors across the country — and a detailed survey, making it more definitive than past research, experts say. The results, they say, also show a strong endorsement of electronic health records by doctors who have them, especially for what the report termed “fully functional” records, which include reminders of care guidelines, based on a patient’s age, gender or medical history. For example, 82 percent of those using such electronic records said they improved the quality of clinical decisions, 86 percent said they helped in avoiding medication errors and 85 percent said they improved the delivery of preventative care.

“Those numbers are huge and very encouraging,” said Dr. David J. Brailer, the former health information technology coordinator in the Bush administration. Dr. Brailer also pointed to the 54 percent of doctors without electronic health records who said that not finding an electronic health record that met their needs was a “major barrier” to adoption. In short, they are not satisfied with the existing products, which tend to be designed for hospitals — big customers — instead of small practices.

“What we see is a deficit in innovation, and that is something innovators and the capital markets can address,” said Dr. Brailer, who leads a firm that invests in medical ventures, Health Evolution Partners.

One wave of innovation is coming from big technology companies, like Microsoft and Google, which recently have begun services that offer consumer-controlled personal health records over the Web, which are stored in the companies’ data centers. These consumer-controlled health records are intended to link up and exchange information with electronic patient records in doctors’ offices and hospitals.

Dr. Peter Masucci, a pediatrician with his own office in Everett, Mass., embraced electronic health records to “try to get our practice into the 21st century.” He could not afford conventional software, and chose a Web-based service from Athena health, a company supplying online financial and electronic health record services to doctors’ offices. Dr. Masucci was already using Athenahealth’s outsourced financial service, and less than two years ago adopted the online medical record. Today, Dr. Masucci is an enthusiast, talking about the wealth of patient information, drug interaction warnings and guidelines for care, all in the Web-based records.

“Do I see more patients because of this technology? Probably no,” Dr. Masucci said. “But I am doing a better job with the patients I am seeing. It almost forces you to be a better doctor.”

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Original Article

Taking e-Health to the next level

Chief executive officers, chief information officers and other senior managers from healthcare provider organizations across Canada, along with representatives of sponsoring supplier firms, shared a diverse set of views and some fascinating insights into healthcare IT implementation challenges at the eighth eHealth Summit, held June 11-13 in Mont Tremblant, Que. The conference is organized annually by Canadian Healthcare Manager http://www.chmonline.ca).

An overview of the current status of eHealth in Canada was provided by Shelagh Maloney, executive director, external liaison, for Canada Health Infoway. Roughly one in three youth and adults in Canada — nine million people — are living with one or more medical conditions, Maloney said. Central to addressing the critical challenge of managing chronic diseases is to get these patients involved in their care.

“If you’re like a growing number of Canadians,” she noted, “you want to take an active role in managing your healthcare.” Maloney cautioned that there’s no quick fix to this problem — a point that was repeated by other speakers at the summit. She referred to the progress that’s being made toward implementation of electronic health records (EHR’s), but also eluded to an area that became a minor theme throughout the conference: health consumerism.

“The health consumerism trend is creating an environment where providers and patients alike want the right information, at the right time, to make the right decisions,” Maloney said, adding that consumer eHealth solutions, many of which deliver a broad range of information to patients, are gaining support.

CANADA’S progress in eHealth was put into a global perspective by Susan Hyatt, president and CEO of the corporate strategy firm HyattDIO Inc., and a former vice-president at Canada Health Infoway. A “global business platform” for the delivery of healthcare is being enabled by eHealth, she said, in which English is the pervasive language, brands are going global and eHealth infrastructures are prevalent, even in poorer countries.

“We’re seeing the emergence of a global healthcare bazaar,” Hyatt said. “And when things go global, everyone is affected.” To stress the point, she showed a map of the world in which such unlikely candidates as India, South Africa and China were identified as having “strong EHR, eHealth activity.”

Common to all national initiatives are a clear and well-articulated vision, a common architecture, and transparent governance and accountability frameworks. In Canada, however, there are some additional factors at work. “The privacy commissioners in Canada are engaged in early dialogue,” said Hyatt. “As well, Canada has portfolio management with targeted investment programs, and a well-defined co-investment strategy to manage risk.” However, there’s one significant area where Canada, along with the United States, lags: the adoption of electronic medical records (EHR/EMR’s) by primary-care physicians. This problem is well-known, yet Hyatt acknowledged that solving it remains something of a conundrum.

IN THE SUMMIT’S keynote presentation, Kevin Leonard returned to the question of technology and the role of the patient in managing chronic diseases more effectively. Leonard is associate professor in the Department of Health Policy, Management and Evaluation at the University of Toronto, and research scientist at the University Health Network’s Centre for Global eHealth Innovation.

The economic logic for patient involvement is compelling, Leonard said: “Out of a total healthcare spend of $146 billion in Canada; about $90 billion is for chronic diseases. And it’s estimated that of this, $50 billion is spent on providing information such as test results, care advice and repeat prescriptions.”

Just as customers having access to their personal financial information has reduced the banking industry’s costs, great savings will also be gained in the healthcare system, as more patients bypass the “hands-on” personal method and obtain personal health information for themselves. Consequently, a tremendous amount of strain will be removed from the healthcare system. Consumers from all types of industries are playing larger roles in both purchasing and developing products and services. The growth of social networking websites such as YouTube and Facebook are prime examples. In healthcare, however, such grass-roots contributions have been slower to come to the fore, although recent initiatives like Google Health, Microsoft Health Vault and Patients are emerging as alternatives to the status quo.

Healthcare has been slow off the mark in this area, Leonard suggested, because the system uses language and jargon that’s not accessible to the average consumer, and because patients may not yet appreciate the benefits to be gained from better access to their information. As well, there are no “information access” points to facilitate communication between patients and the healthcare system.

Ultimately, patients lack the encouragement, the education and the means to gain the information they need. To get patients more involved in an effective way, Leonard argued that more research is needed to determine how to do it properly. This research might help answer several questions, for example:
• How should patient access to EHR’s be supported?
• Who should control access?
• Does this lead to improved patient outcomes?
• How does increased record ownership address privacy issues?

He proposed that for these and other questions to be answered effectively, patients need representation by a formal organization. “This organization must represent both the ill (chronic and otherwise) and recognized, and invited to the table with other organized stakeholders.”

ONE OF THE KEY challenges in eHealth implementation is that of leadership, an issue that was addressed at the summit by John Hylton, president and CEO of John Hylton & Associates, and Canadian Healthcare Manager’s regular leadership columnist. Hylton presented some startling statistics: 90% of healthcare organizations run without a plan, and of the 10% that do have a plan, 90% fail to execute their strategies successfully. As well, 95% of a typical workforce doesn’t understand its organization’s strategy, and 60% of organizations don’t link strategy to budgeting. To the extent that eHealth and technology fit into an organization’s strategy, this lack of foresight can lead to some big problems.

“It needs to be recognized that different stakeholders want different things from health reform and from health technology,” said Hylton. “Unless we can agree on what we’re hoping to achieve, the wheel-spinning will continue.”

It’s also important to realize that technology is not a panacea. “Many expect way too much too soon from technology, while others harbor disappointment and even resentment about failed technology projects,” he said. “The truth is somewhere in between.” Hylton warned that if we consider all of healthcare’s many technology needs together — not only eHealth and information and communication technologies — then its apparent our current ability to assess, deploy and pay for innovation is inadequate.

“It’s also helpful to remember that there are many healthcare issues that preoccupy funders, administrators and trustees,” he said. “Technology is just one. Constant change and shifting priorities have created a planning environment that frustrates intelligent planning and decision-making, and there’s no doubt this impacts technology planning and decisions as well.

“As the OHA, for example, recently observed, ‘the current funding environment does not effectively support the adoption, collaboration and integration necessary to enable the realization of eHealth’s true value.’” Hylton said improvements in the use of technology will only come about when healthcare leaders, particularly system leaders, start to be much more intentional about the path they want to follow. Moreover, in every healthcare system, some individual or team has to “own” this priority. Budgets and personnel must be aligned to ensure success, and incentives need to be put in place that are directly tied to achieving measurable improvements in the uptake and effective use of technology.

“Strategy-focused organizations work through competing challenges and interests to identify the key strategic priorities that are most important for achieving improved performance,” he said. “The bottom line is that we need more strategy-focused organizations in healthcare. You might say all this is Management 101, but the fact of the matter is that our health system needs more Management 101.”

THE LEGAL risks involved in the implementation of EHR’s were the subject of a presentation by Richard Corley, partner with Blake, Cassels & Graydon LLP, who described his perspective as that of a “deal lawyer specializing in complex IT and outsourcing transactions in the healthcare field.”

The development of eHealth in Canada has seen a rapid increase in complex IT health system deals, Corley said, and recently the deal structures have tended towards more integrated multi-vendor environments, smaller and shorter deals, more onshore/offshore combinations, and a greater emphasis on better governance. There are expanding legal requirements around privacy, security, record disposal, medical device regulation and liabilities for claims. The laws and regulations that apply most directly to healthcare providers are the requirements under federal and provincial privacy laws in Canada, including the Personal Information Protection and Electronic Documents Act (PIPEDA) and the more directive requirements under the Health Insurance Portability and Accountability Act (HIPPA) in the United States, whose security rules apply to the storage, maintenance or transmission of electronic protected health information by health plans, healthcare clearinghouses and healthcare providers.

There are numerous requirements for security in EHRs, Corley noted, including subcontractors’ breaches and the losses and thefts of storage devices. Another concern, which has made the news on too many occasions in Canada, is the improper destruction of paper-based records and EHR’s. He also discussed the risks posed by projects that integrate and implement new eHealth information systems with existing systems and/or outsource the provision of such services to a third-party service provider. Integration and outsourcing projects are notoriously difficult to implement effectively and many have proven unsatisfactory, he said.

Best practices for IT integration include: clarifying objectives and gaining executive support for the project; clearly documenting requirements, scope and costs; securing expert help and internal support; good governance before, during and after implementation; allowing enough time for due diligence; avoiding unnecessary complexity; maintaining required flexibility; planning transition and repatriation; ensuring that required expertise is maintained; and having a contract to address contingencies.

WHERE WILL eHealth be by 2015?
Offering answers to that question at the eHealth Summit was an expert panel that took out its crystal ball and peered into the future. The panelists were David Cowperthwaite, project manager for Panorama; George Eisler, CEO of the BC Academic Health Council; Michael Lauber, chair of Ontario’s Smart Systems for Health Agency; and Judy Middleton, CIO of the William Osler Health Centre.

The panel was by no means filled with wide-eyed optimism, but it did express confidence that by 2015 EHR’s would be in place for the majority of Canada’s population. However, there was consensus, albeit from varied viewpoints, that achieving that end will produce further resourcing and funding challenges: once the eHealth infrastructure is built out, how will it be maintained?

“There’s a big difference between implementation and adoption, and usage for benefits,” said Cowperthwaite. “I worry that a lot of people will still not be getting good care in 2015, and there will remain an enormous gap with First Nations.”

Lauber was more optimistic that technology could be delivered to rural areas, and that enhanced broadband delivery will ensure the viability of initiatives such as telehealth. Eisler, however, worried that Canada won’t have enough people trained in technology to maintain the system.

From a hospital perspective, Middleton echoed this concern, because advanced facilities will require both predictable funding and access to highly qualified personnel.

The ninth annual eHealth Summit will be held June 10-12, 2009, in Montebello,
Quebec.

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The eHealth Summit http://www.hfconferences.ca/ehealthsummit/ Series is an annual forum (organized by Canadian Healthcare Manager Magazine http://www.chmonline.ca) for Canadian healthcare executives to exchange ideas, find out about innovations, share common challenges and discuss the strides that have been made in eHealth implementation across the healthcare continuum. The spirit of the conference is purely educational and 'think-tank' oriented.

Canadian Health Records Situation A Travesty

Janet French | The StarPhoenix | Wednesday, July 02, 2008

Canada's foot-dragging on embracing electronic health records is a flaw in the system as revealing as a patient's paper hospital gown, a longtime national health reporter says.  Globe and Mail public health reporter Andre Picard told a Health Quality Council conference on transparency in Saskatoon Friday the nation's lack of electronic health records is a "travesty" that helps make personal health information tricky to get and hard to understand once you do get it.

"Metaphorically, our butt-cracks are showing," he told about 200 conference attendees, who tittered at the remark.

Canada's health system needs to break out of the culture where basic health information -- including your blood sugar readings, blood pressure, cholesterol levels and how those numbers change over time -- is rarely shared with the patient and treated like a "state secret," Picard said.

"We're still in the era of paternalism," Picard said. "We're changing, but we're not changing quickly enough."

Picard gave the example of returning from a trip to Malawi with a parasite. When Picard asked his specialist what the name of the parasite was, the doctor was puzzled about why he wanted to know.

"Why do I want to know what's living in my body?" he said. "I just couldn't believe the arrogance of that. But it's not that uncommon, unfortunately."

The information in medical records belongs to patients, not health-care providers, he says. Standardized, electronic records available throughout the system would simplify access, Picard says. Patients might fare better if they approached health care like they shop for a vehicle, Picard said later in an interview.

"If you go to buy a car, you want the manual," he said. "If you get it fixed, you're not only going to get the bill, you're going to get an explanation of what went wrong and maybe you can avoid it happening the next time. It's the same philosophy."

Too many patients are compliant when they'd be better off asking questions, he said. "They have a great deal of respect for their physicians, which isn't bad, but it's taken too far. We just sort of take their word as gospel."

There's a bonus to inquisitiveness: Research shows engaged patients are healthier, less likely to experience a medical mistake and cheaper for the health-care system, he said.

"I think he's right," said Jean Morrison, the Saskatoon Health Region's vice-president of performance excellence and chief nursing officer, after Picard's talk. "We're a public institution, and people have the right to their information and they have a right to information about what goes on within public institutions."

Bobbylynn Stewart, the region's acting privacy commissioner, says it's "very easy" for patients to see their health records. The department will make copies at 25 cents a page and if an inpatient requests to see his or her chart, a staff member will explain what the jargon means.

Morrison admits many patients would not be able to understand their records without help. The region strives to eventually include a written analysis of tests in the notes to make records more comprehensible, she said. Although lab results, prescription information and diagnostic images are now computerized, Morrison estimates less than one quarter of the region's health records are electronic. The region would like to be paperless, but the provincial government will have to pony up the cash to make it happen, she says.

"Creating electronic records is a costly business because you are truly transforming the health system," Morrison said. "It's the software, the hardware, it's the training of the people, it's the way you do business. It's a multi, multimillion-dollar issue to do that. In the Saskatoon Health Region, we're talking tens-of-millions of dollars."

For skeptics who think information should be kept tightly under wraps, Picard points to Canada's tainted blood scandal, or the Newfoundland scandal where flawed breast cancer tests were done on women for eight years before the health authority admitted the errors.


"We can look at all kinds of elements that came into play, but No. 1, the starting point for that, was people covering up information and not being open about it," he said.

"In my experience, the price of secrecy and the price of paternalism is dead patients and wounded patients," he added.

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jfrench@sp.canwest.com

Using “Virtual Reasoning” to redefine Healthcare

by Dr. Marlene Beggelman

The Internet is redefining the health care industry. Major transformations can be expected because Internet-based technology will deliver certain health care services more effectively and at lower costs. In the near future, much of the information that is currently imparted to consumers by clinicians will be delivered through and by web-based technology. If the web-based tools that deliver this information mature to the point of becoming reimbursable, beyond their current usefulness as value add-ons, the health care industry could experience a dramatic shift.

Tools
Early stage Health 1.0 information has predominantly been available in the form of an “e-pamphlet” with a one-size-fits-all approach. Subsequent generations of Health 2.0 tools are interactive and deliver personalized, and therefore more valuable information that is geared specifically to the user’s input. With the advent of advanced tools, consumers are no longer limited to being passive recipients of pamphlet-style information; in these milieus they interact with each other or with sophisticated software that analyzes cases on an individualized basis. Advanced tools are being used by Internet entities as bait both to drive traffic and to capture detailed user profiling data.

Several categories of interactive Health 2.0 tools are available, including advanced search engines that deliver more accurate results; social media sites in which individuals hone their medical knowledge through interactions with each other; and finally, expert systems - sophisticated software programs that analyze a consumer’s profile and, based on the analysis, pinpoint the most relevant educational information necessary to support the consumer’s health care decisions. Expert system tools basically simulate human reasoning.

Virtual Reasoning – a New Model
Speculation about where Internet health care might be taking us can be approached, in part, as a projection of the next generation of the most advanced web-based health care tools. If what consumers and payers want from health care is an acceptable cost-quality trade off, assurance that care is appropriate for the situation, that the diagnosis is correct, and that errors of commission and omission are kept to a minimum, web-based tools need to move beyond simple information retrieval to the level of analytic services – expert systems that are virtually capable of reasoning, rather than only presenting facts.

If Health 2.0 products bring you cholesterol guidelines, then virtual reasoning tools, in counter-point, should calculate your LDL (bad cholesterol) goal based on your level of risk for heart disease and assess whether or not you are taking the right medicine. If Health 2.0 delivers personalized information, virtual reasoning systems offer the equivalent of a virtual second opinion.

As virtual reasoning tools reach a greater level of maturity, they will represent cost-effective alternatives to certain health care services traditionally performed face-to-face by health care professionals. At some point, they will cease to function merely as value add-ons and become reimbursable, revenue-realizing businesses in their own right, augmenting some of the educational and analytic services now in the purview of health care providers.

The logical end-point of expert system and decision-support adoption will be a new reimbursable segment of the service industry in which lower cost services are rendered through technology solutions. When physicians are reimbursed to use expert system technology, they will have sufficient incentive to adopt electronic medical records (EMR/EHR) as well.

For tools to replace certain traditional face-to-face services they have to be integrated into the clinician’s normal workflow and electronic medical records systems. EMR/EHR companies will first incorporate expert system tools for much the same reasons as the PHR initiatives do – for the value-added benefits they offer to the customer base. In future models, though, fully integrated tools will sit “under the hood” of an EMR/EHR, continually combing the medical record data for errors and oversights as new data is entered. They will compare treatment to evidence-based recommendations, follow response to treatment over time, generate outcomes data, and generally function as an automated quality assurance system.

Physician Adoption
Physicians will ultimately be reimbursed for the time they spend administering care through the medium of information technology. Early pilots will likely be initiated by payers (large, self-insured employers) who believe that the potential for improved, more appropriate care will result in significant cost-savings. These technology adjuncts will free health care professional from the mundane functions of data gathering, recording, and administering; they will enable physicians to focus on the more rewarding cognitive aspects of medical practice. With more free time, physicians can move squarely into a consultancy role in which they help their patients assimilate and analyze increasingly complex choices.

Significant activity around tool adoption is already underway: Microsoft, Google and other Internet companies have been acquiring advanced search and expert system tools; programs in which web-based service delivery is reimbursed are being piloted; and Google Health has taken the first steps to make a large number of tools available on their platform. How quickly the process eventually unfolds depends on a number of factors that mostly revolve around any upcoming changes in health care financing and in the political climate. No matter how health care financing is structured, however, the need for tools that enhance health care quality and efficiency still applies.

Dr. Marlene Beggelman is the CEO of Enhanced Medical Decisions, which is the company behind DoubleCheckMD.com.

Google Health and the Personal Health Record (PHR): Do Consumers Care?

By Keith Schorsch

Google Health’s unveiling last week and Microsoft’s HealthVault launch last October are important milestones in the evolution of Health 2.0. Both of these heavyweights have the resources and potential to improve the health consumer’s customer experience. I have followed the active (and important) conversations about privacy concerns, HIPAA, and Google Health’s terms of service, which are well represented by Erik Schonfeld’s post on Techcrunch and Larry Dignan’s post on ZDnet. And I read with interest Google’s rapid response offered by Google Senior Product Counsel Mark Yang.

What’s missing from all of these conversations is the elephant in the room. Namely, do consumers really care about having online personal health records? Current evidence suggests that less than 3 percent of health consumers maintain a PHR online, according to Lynne Dunbrack, program director at Health Industry Insights, who commented in a recent interview. It reminded me of the post on The Health Care Blog a couple of years ago, PHRs, EMRs, and pretty much useless surveys.

And while Google trotted out some great enterprise partners last week for its announcement, I didn’t hear any consumer voices or testimonials on how Google Health will fulfill an unmet need. To me, PHRs and electronic medical records remain an industry-driven vision, not a consumer-driven one — focused on efficiency and reducing costs. It seems we’ve lost sight of whether the consumer really desires and is willing to participate in these services. What are the circumstances for using a PHR and do the benefits outweigh the perceived risks?

Google Health does seem simple, straightforward, and easy to use, albeit with some major holes in content and functionality that I imagine will be filled over time. However, I struggle to see how it’s creating value for the average health consumer. Yes, data portability is important in some sense and does add a level of control for the consumer, but how much work is required by the user to create this asset? And how important is data portability to the consumer? We all remember the predictions of the paperless office. The “paperless record” feels like this decade’s version of the “paperless office.”

The best news around this announcement is the upcoming Google API that will allow others to create applications on this platform. There are myriad privacy and security issues with data moving from Google to third parties. For example, I’m not sure what personal health info was sent to Daily Apple when I signed up for their widget, nor am I fully aware or comfortable with Daily Apple’s privacy and security. But despite this, I think the API holds the most promise for consumers.

The bottom line, for me anyway, is that Google Health feels like a good, incremental step toward putting more control in the hands of the health consumer. People should have more information about their next treatment or medication than they do about their next book or automobile. Without a clearly delineated consumer benefit, however, this is a platform waiting for a killer app.

Keith Schorsch is the founder and CEO of Trusera.com, a social health Web site. Read Original Article.

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

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

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

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

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

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

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

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

The Emergence of the Patient Portal

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

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

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

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

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

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

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

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

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

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

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

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

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.
Read original article.

Google Health opens, sparks privacy woes

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

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

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

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

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

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

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

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

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

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

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



View Original article.

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

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

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

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

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

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

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

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

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

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

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.

View Original Press Release

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]