Thought Leader Series | "Patient Portals"

by Peter Kuhn | October 08, 2008

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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RESPECT, TEAMWORK AND COLLABORATION

By Michelle DiEmanuele, President and CEO of Credit Valley Hospital

Hospitals are huge and can be intimidating institutions, not just for the patients, but for a new CEO such as myself. I am quite frankly overwhelmed by the amount of teamwork and collaboration that exists here at Credit Valley and beyond our doors with our health-care partners. This is great news, for if we are to move forward with our quest to deliver patient and family-centred care and to ensure equitable and sustainable access for all, we must forge even stronger relationships. And we’ll do so if we make teamwork, collaboration and partnerships our top priorities.

Gone are the days when hospitals competed with one another for scarce financial resources in order to duplicate programs and services at each facility. What’s critical is the idea of mutual respect - within the hospital and broader health-care environment recognizing the significant role each facility, each program and each individual plays in the overall delivery of good patient care. It is critical to maintaining that community connection and understanding as we build and reform the system.

The spirit of cooperation has been accelerated through design and demand of the various regional health systems across the country. Even before the formalization of such systems, there have been many informal and spontaneous examples of co-operation among health-care facilities. I’m hugely impressed by these initiatives that often begin at the community and grass-roots level.

Here at The Credit Valley Hospital in Mississauga, Ontario, we are working closely with our neighbouring hospitals and other health-care partners to offer our patients more comprehensive and coordinated services, each through our own regional specialities. The patient experience is further improved because in many instances, they no longer have to travel to Toronto or Hamilton or other larger centres for their care, reducing their travel costs and anxiety.

In order for this collaboration to work, we have all put new resources into making sure our patients are being informed and navigated appropriately to find the care they need, where and when they need it. It’s not always where they thought they might get it. In fact, it may not even be in a hospital environment. That’s asking a lot of our patients. Doing our best to make the move between facilities and caregivers as seamless and painless as possible is paramount to a good patient and family-centred experience. One way we do that, is through the REACH web portal.

The collaboration initially between six physical hospital sites in Peel and Halton regions (Credit Valley, Halton Health Care and William Osler Health Centre) means all of our 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 web connectivity is growing between more hospital sites which will allow even more physicians to access clinical data from disparate systems through one unified view. This allows physicians to easily review their patient’s records, lab results, cardiology images, diagnostic (PACS) images, transcriptions and progress reports. Because the ehealth record shows their 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 any of the health facilities on the REACH network.

Within our own four walls at Credit Valley, the team approach to problem solving has made significant improvements toward patient and family-centred care, most recently in our regional cancer centre. Cancer patients have spent seemingly endless time between appointments for tests and treatment in the same building. The Stream Team, made up of oncology doctors and nurses, clerks, lab, pharmacy and information systems with input from staff, patients and volunteers, set out to redefine their patients’ experience. They charted every step, every process, every wasted minute and after several months, they had streamlined ten processes to seven and decreased the patients’ waiting time by almost two hours! Nurses and doctors collaborated on patient assessments; volunteers took on responsibility to ensure patients moved smoothly from one process to the next and now, there’s the potential to see even more patients each day.

I believe leadership happens at every level within an organization that values and respects the roles of every individual – not just the caregivers – but the patients and families we are here to serve. I saw that first hand as I worked alongside the men and women cleaning stretchers in our emergency department; as I sat beside the charge nurse who was more like an air traffic controller as she juggled patients, personnel and stretchers throughout her shift. I believe the role of leadership is to create the conditions for success not just in terms of the hospital, the system or even the government. Everything we do, every decision we make, should be prefaced with the question, “what’s best for the patient?” This isn’t easy. It’s takes a sense of respect for everyone at that table and the courage to push the traditional boundaries and norms to embrace innovative solutions. But without that respect, the kind of changes our hospitals need will be too slow for what our patients deserve – and increasingly, demand. Respect, teamwork and collaboration have and will make the difference in elevating patient care.

Is that respect there? You bet. Having re-entered the health-care sector, I’m humbled daily by the unbelievable dedication on the part of doctors, nurses, clinicians, and administrators who put their patients first in a system where that isn’t always easy.

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Michelle DiEmanuele is the President and CEO of the Credit Valley Hospital in Mississauga Ontario.

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PROVINCE OF ONTARIO INTEGRATES ELECTRONIC HEALTH ACTIVITIES UNDER ONE AGENCY

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

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

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

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

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

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

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

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

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

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

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

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Healthcare Posturing: Where the parties stand on your health

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

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

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

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

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

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

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

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Saturday, September 27 | Read original article.

REACHing for Leading-Edge Patient Care with e-Health

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

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

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

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

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

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

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

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

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

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

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

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CLINICAL INFORMATION ACCESS IMPACTS RADIOLOGY INTERPRETATION

September 18, 2008 | Clinical Studies

The majority of radiologists at eight academic medical centers are dissatisfied with their ability to access clinical patient information at the time of interpretation, according to results from a report published online before print in the Journal of Digital Imaging. The report also indicates that the lack of access to pertinent clinical patient data may be a critical element that limits the accuracy of the radiologist’s diagnostic decision-making process.

“Given the increasing volume of radiological exams, the decreasing frequency of direct communication with the referring provider, and the distribution of patient data over many clinical systems, radiologists often do not have adequate clinical information at the time of interpretation,” the authors wrote.

William W. Boonn, MD, and Curtis P. Langlotz, MD, PhD, of the department of radiology at the Hospital of the University of Pennsylvania in Philadelphia, designed the survey. Among its 27 questions were an assessment of the IT environment in which the respondent practiced, including how radiology orders were typically processed and how images were displayed for interpretation. In addition, opinions about acquisition and access to relevant clinical patient information, both at the time of the examination and in follow-up, were obtained.

A total of 139 radiologists responded to the survey, with the vast majority (90 percent) practicing in an academic setting. Slightly more than half (54 percent) were attending radiologists; the remainder of the survey cohort was comprised of radiology fellows and residents.

The survey found that 72 percent of the respondents reported that they frequently needed more clinical information about their patients than was available at the time of study interpretation. More importantly, 87 percent acknowledged that additional clinical information was significant and that this information could change or modify the interpretive report.

“Of the available sources of information, radiologists reported that outside radiology reports, admission notes and progress notes typically yielded their preferred clinical information,” the authors stated. “However, despite their desire for these information sources, they reported using them less than 15 percent of the time.”

More than half (53 percent) of the respondents indicated that their reasons for not seeking access to additional clinical information was that such efforts were too time consuming.

Obtaining follow-up data on patients proved to be equally problematic for radiologists. The authors reported that clinical follow-up information was predominantly obtained either through discussions with the referring clinician or through subsequent imaging or pathology reports.

“Our findings demonstrate that most radiologists want more clinical information when interpreting images and that this information would impact their report, but they are discouraged by the time it takes to access this information,” the authors noted. “In addition, current mechanisms for monitoring necessary patient follow-up are inadequate.”

Boonn and Langlotz observed that many hospitals have multiple different systems used to access clinical data, which presents challenges to radiologists through multiple logins and user interfaces. In addition, legacy systems may not be fully integrated throughout the healthcare enterprise due to nonstandard, proprietary interfaces.

The pair believes that their survey indicates the critical need for an integrated application for the automatic identification, selection, retrieval and display of pertinent patient information at the time of interpretation. In addition, this application needs to provide alerts and reminders for patient follow-up.

“Together, these applications would have a significant impact on the satisfaction of radiologists, the quality of radiology interpretations, and thereby on the quality of care,” they wrote.

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

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

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

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

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

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

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

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

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

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

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

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

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

CANADIAN TERRITORY RECEIVES FUNDING FOR REGIONAL EHR INITIATIVE

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

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

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

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Original Article.

Clinical Portal Vendor MEDSEEK leads in 2008 KLAS® Rankings

MEDSEEK Leads KLAS® Portals Segment as of August 22, 2008.

Birmingham, AL (PRWEB) September 4, 2008 -- MEDSEEK, a leading provider of enterprise portal management solutions, announced today it leads in KLAS® rankings for its Clinical Web Portal software solution.

KLAS® is an independent healthcare market research firm that gathers data about clinical portal solutions from CIO's, Directors, and other healthcare providers about software functionality, solution performance, technical support and service. According to the August 26, 2008 Platinum KLAS ® database, MEDSEEK has the highest current performance ratings, outscoring all other clinical portal solutions.

Peter Kuhn, President of MEDSEEK commented, "MEDSEEK's superior ranking in the KLAS ® report highlights our effort to provide comprehensive eHealth solutions." Kuhn added, "We frequently receive high praise from our clients on our ability to deliver complex installations on time and on budget. The KLAS rating validates our reputation as an organization that consistently delivers on our commitments."

The KLAS® database also reports anonymous comments from providers who are using the eConnect Clinical Portal solution: "The implementation process was very smooth. It was very well planned and organized and was executed according to that plan. The planning was very thorough and there were few surprises and gotchas along the way. The implementation staff MEDSEEK provided was very knowledgeable. They were excellent communicators. We were able to install the system on time and within budget.” (Quoted from a healthcare provider interviewed by KLAS, see KLAS® commentary August 26, 2008.)

"MEDSEEK eConnect is the perfect portal solution for our physicians who do not want to learn the complexities of using the PACS and hospital clinical systems. This product is a single sign-on system that helps doctors get to patient information quickly. We have heard nothing negative from the physicians. All of the feedback about using eConnect for pulling results has been good, and the doctors love being able to pull images by using a URL." (From the KLAS ® database, August 26, 2008.)

Michelle Wickham, Research Director for KLAS stated, "KLAS applauds those vendors who utilize KLAS® data to understand and respond to their customers' needs. We are pleased when the data shows that a vendor is performing well, and we plan gather data on an ongoing basis to continuously monitor vendor performance in this segment."

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About MEDSEEK:
Birmingham, Ala.-based MEDSEEK provides healthcare organizations with Enterprise eHealth solutions to fully engage and strengthen relationships with key constituents - physicians, patients, employees, and consumers. By connecting information and communities to foster an enhanced experience with the organization, hospitals will improve community advocacy, revenue and patient acquisition/retention, physician relations, and clinical decision making.

MEDSEEK's comprehensive technology platform and strategic consulting services create the infrastructure and provide the thought leadership for hospitals to deliver the most powerful Portal solutions. With more than ten years' experience and 600+ hospital customers, MEDSEEK has the experience and expertise to meet the diverse needs of the healthcare community. MEDSEEK also maintains offices in California and Mississippi. In Canada, Medseek is distributed by Agfa HealthCare. For more information, visit MEDSEEK or call 888-MEDSEEK.

About KLAS:
KLAS is a research firm specializing in monitoring and reporting the performance of healthcare vendors. KLAS' mission is to improve delivery, by independently measuring vendor performance for the benefit of our healthcare provider partners, consultants, investors, and vendors. Working together with executives from over 4500 hospitals and over 2500 clinics, KLAS delivers timely reports, trends, and statistics, which provide a solid overview of vendor performance in the industry. KLAS measures performance of software, professional services, and medical equipment vendors. For more information, go to www.KLASresearch.com, email marketing@KLASresearch.com, or call 1-800-920-4109 to speak with a KLAS representative. The data referenced was retrieved Tuesday, August 26, 2008 and fluctuates daily. Copyright 2002-2008 KLAS Enterprises, LLC. All rights reserved.

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Read Original Article

PROVIDER E-HEALTH PORTAL ALLOWS REGIONAL HOSPITALS TO SHARE DATA

In 2005, the Ontario government decided to transfer the operation of Georgetown Hospital from William Osler Health Centre to Halton Healthcare Services. During the transition, historical clinical data was left on the Osler system, and after the transfer, many of the physicians remained at Georgetown and still provided service to Osler. In order to provide clinicians with access to patient data from both organizations, a “provider portal” was deemed the best approach to meet the clinical data sharing needs of physicians and clinicians.

The IT staff from Halton and Osler worked together to identify available vendor solutions, and during the request for proposals process, three other hospitals — Credit Valley Hospital, Trillium Health Centre and Headwaters Health Care — became involved in the evaluation because it was felt they might join the network later. In 2006, Credit Valley acquired a licence for the provider portal; Trillium and Headwaters followed in 2008.

In a presentation at the eHealth Summit, Dan Germain, vice-president, CFO and CIO at Credit Valley, explained how the Rapid Electronic Access to Clinical Health Information (REACH) system was deployed. The REACH provider portal (provided by Medseek) is a web-based Portal solution that consolidates clinical patient data from disparate vendor systems (in real-time) into a unified, patient-centric view regardless of site location.

Currently, the REACH portal allows viewing of allergies and alerts, laboratory results, pharmacy medications, pathology reports, radiology images and reports, ECG tracings, clinical orders, clinical documentation, scanned paper records, rounding reports, and other clinical data. It’s developed on a federated data model, where data is stored at each entity. The REACH server consolidates the clinical data in real time, presenting it to the user in a web browser in milliseconds. It's similar to a Health Information Access Layer (HIAL.)

The REACH portal also employs an Enterprise Master Patient Index (EMPI.) However, once access is granted to use the Ontario EMPI, REACH will interface to that application. The Credit Valley Hospital's IT team was impressed by the speed with which this application was deployed, Germain said. Implementation was accomplished over a few months, and in the words of users, testing was similar to a systems upgrade. Since the application is very intuitive, users required little if any training.

Before deployment at CVH, a privacy impact assessment was performed. The only significant recommendation was to mandate the use of a pass-code keyfob for remote access via the Internet. Since patient-specific data is only stored once, responsibility for data security and integrity remains with each host hospital.

By the spring of this year, William Osler, Halton and Credit Valley were using the provider portal extensively. Every month, hundreds of physicians and clinicians log onto REACH, one-third of whom are users looking at their patients that have been seen at other facilities. There are now over 9,000 views per month. As well as integrating into the Ontario HIAL and EMPI, Germain said future plans for this initiative include additional clinical content such as operating room systems and realtime physiological wave-form monitoring. REACH is also to extend a Patient Portal providing patient's range of other self-care services directly accessible online.

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Canadian electronic health record (EHR) projects quadruple in four years

By Richard Pizzi, Associate Editor 08/12/08

Canada's electronic health record projects increased by 12 percent last year and have quadrupled since 2004, according to Richard Alvarez, president and CEO of Canada Health Infoway.

"Canadians want their medical information available electronically to the clinicians who care for them and that's starting to happen in communities across Canada," said Alvarez.

“Collaboration among governments is at an all-time high and with continued federal funding, we are well on our way to providing every Canadian with an electronic health record by 2016."
Canada Health Infoway is an independent, not-for-profit organization funded by the Canadian government. It jointly invests with every province and territory to accelerate the development and adoption of EHR projects in Canada.

Infoway approved $311.5 million in new EHR investments in 2007-08, bringing the total cumulative value of its investments to $1.457 billion, or 89 percent of Infoway's $1.6 billion in capitalization by the Canadian government. The investment brings the total number of projects underway to 254, representing a four-fold increase from the 53 projects that were underway in 2004.

"The electronic health record projects the government of Canada is investing in are coming alive (and) bringing tangible results," said Tony Clement, Canada's federal minister of health.

Clement noted, for example, that in Nova Scotia, a shared diagnostic imaging program provides digital images of X-rays, MRIs, CT scans and ultrasounds to authorized healthcare providers. He said patients in Canada's remote northern communities are connected with healthcare professionals in urban centers through telehealth, and electronic medical records are generating results in the face of growing clinician shortages and administrative demands.

Alvarez said he's seeing steady progress in all Infoway-funded electronic health record programs including registries, diagnostic imaging and laboratory and drug programs. He said Infoway would continue to target investments in "replicable solutions that support health system transformation, such as telehealth and public health surveillance."

Read Original Article

Healthcare and Web 2.0

Healthcare systems are undergoing a series of complex transformations. Consumers are demanding better services and information that enables provider transparency and a more personalized service delivery model. This shift in healthcare has already begun, whether or not healthcare delivery organizations are ready to respond or not. We are quickly moving away from the traditional models of medicine and towards a patient-centric model with the intent to deliver more efficient care, whilst simultaneously improving patient outcomes.

The advent of new web 2.0 eHealth technologies is serving as a powerful catalyst and today’s savvy consumers (patients) are demanding that the often slow-moving healthcare industry act in response to their evolving needs.

The increasing expectations of consumers is a clear reflection of wider societal changes that have been evolving for a number of years, however, the pace of these trends has recently accelerated. In particular, the ability to articulate and communicate (1:1) individual preferences and demands has been made far easier with advancing web technologies. Such tools, for example, have enabled even novice internet users to create and edit content online. It’s clear; 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.

Patient Empowerment
Empowering patients to take more control over their health extends to those actions individuals and take for themselves, their children, their families and others to stay fit and maintain good physical and mental health; meet social and psychological needs; prevent illness or accidents; care for minor ailments and long-term conditions; and maintain health and well being after an acute illness or discharge from hospital. This “Self-care” is also one of the key building blocks for patient-centric healthcare delivery, and research shows that supporting self-care improves health outcomes, increases patient satisfaction, and reduces the increasing administrative burden.

This (r)evolution is also driven by things like the increased adoption of online services via broadband and mobile devices; the enhanced ability to connect with individuals in other social networks; the continuing ease in submitting content online; and the growing participation of users with similar interests in online communities. People are flocking to online communities to share personal health experiences as well as learn from others with similar experiences or conditions. Patient feedback on treatments and providers for example, has begun to develop into an online system that generates transparency in the health system. Today’s web-savvy patients are using web tools to take responsibility for managing their own health status and care-path rather than always relying on experts or the 'doctor knows best' assumption. This self-service (self-care) trend effectively bridges the gap between caregivers and patients – before, during, and after the hospital stay and has far-reaching implications.

Heightened Transparency and Accountability
One of the central components of today's healthcare delivery (and public health at large) is information. The use of eHealth (ICT) technologies related to gathering and retrieving patient data is already important and will only become more important in the future.

Millions of dollars are spent each year in Canada alone on patients with chronic diseases who do not receive the recommended care designed to keep their conditions under control. New web 2.0 consumer tools and service models for chronic conditions are taking shape and the trend toward measurement of clinical outcomes is increasing and irreversible. As both regulatory agencies and consumers insist today on measuring the quality of care across a wide variety of clinical areas, “best-practice” treatment models emerge. This follows the growing awareness that quality equals affordability and that the best way to control long-term costs is to provide higher quality care today.

The Electronic Health Record (EHR)
Technology can be intimidating, however Practitioners recognize today that the use of a comprehensive, transferrable EHR promises to protect patients from preventable errors such as medication mistakes, surgical complications, and much more. It’s proven that extending care delivery stakeholders access to timely, evidence-based and expert information, enables more efficient and better-informed decisions. A recent Advertising campaign by Rexall Drugs in Canada identifies that as many as 200,000 Canadians are hospitalized annually from negative interactions with medications. Moreover, a (US-based) 2008 New England Journal of Medicine survey found that “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.”

So, whether the goal is to heighten prevention, detection, integration, or extend patients self-management---our healthcare delivery paradigm is clearly shifting to focus on connecting individuals rather than infrastructure---effectively putting patients (and clinicians) at the centre of new models of connectivity for improved communication and collaboration.

May the dreams of our past be the reality of our future.

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.