e-Health -- the shift has begun

Blue Mountain, Ontario

Spring has arrived! This realization is based purely on the fact that the ski lifts are dormant and the Town has begun its 2012 mowing schedule in the park nearby.
I constantly have to remind myself that the seasons I love always appear ephemeral in nature (sorry -- I couldn't help myself) and that I should constantly seek to maximise my enjoyment of them.

What I believe is permanent, however, is explained in an article that was recently sent to me -- apparently, BC residents can now access their lab results on-line.
I can certainly understand if your response is a nonchalant "so what?", however, for me, this is huge because:

• nothing with such potential to inform will remain a secret for long -- it has to migrate to other Provinces in short order
• once us patients get a whiff of this, the next target has got to be all that paper-based data locked up in healthcare provider (HCP) offices and hospitals

Following patient lab tests, results are sent to the individual HCP who then sorts, records and evaluates to decide if a patient follow-up is necessary; this could take upwards of a week or two, a period of much anxiety for many.

Just imagine if you could access your results within a couple of days -- the afore-mentioned worry is considerably reduced and you'll be able to exercise your options as to whether you'd prefer to evaluate and research the results for yourself, or wait to discuss them with your HCP!

I wouldn't even try to delineate all the functionality that would be made possible by having patient access, but what I can categorically state is this:
although the speed of change will in all probability be evolutionary, on-line access to patient data has the potential to revolutionize the delivery of healthcare, Canada-wide.

So, as a resident of Ontario, I sure am looking forward to the day when I'll able to review my lab results as easily as checking the amount owing on my Canada Revenue Agency (income tax) account.
Hopefully I've piqued your interest!

Wishing you the best of health.


Ernest A. James

President & CEO
Regal Informatics Inc.

e-Health -- would you like a ??? with that!

I recently came across the new MoH model for hospital financing in Ontario, and it really has me fired up!
You see, historically, hospitals have been funded relative to their annual budgets (aka Global Funding), but this policy has now been replaced by a new formula (aka Patient-based funding), which basically stated, is:
number of patients seen + services delivered + quality of those services = funding.
Now, here's where my imagination gets going, for:

• since all hospitals in the Province are under the gun to make quality job one, perhaps we can remove "quality..." from the equation
• since most hospitals are cash-strapped and probably unable to increase the number of services delivered in the short term (you probably won't see your local hospital adding a new wing any-time soon), let's also remove  the "services..." component

So, what we'll be ending up with is an equation where there's a direct correlation between the number of patients seen and funding for your local hospital; you may see where I'm going with this -- your favourite hamburger franchise isn't going to make money much unless they maximise sales, no matter how high the quality or variety!
Note also that the impact of all this will be felt sooner than later -- the "Global Funding" model will be reduced to 30% and "Patient-based Funding" will have to make up the rest of the budget, starting April 2014 -- there's a great overview on the above, courtesy of my LHIN.
It appears then, that the number crunchers at the Ministry have big plans for us, my friends -- they're predicting the number of hospital visits we'll make for the foreseeable future, and basically using the results to  allocate our hospitals' budgets.
It kinda feels like they're banking on us to be even more disease-ridden!

I say we make an effort to thwart those plans, because what we really should be seeing is a policy that encourages increased "Global Funding" expenditures today (in terms of constant "in-your-face" health education, greater use of Information Technology to share patient information, etc.), to effectively decrease the size of future "Patient-based funding" requirements -- educated communities today = healthier communities tomorrow.
After all, it's common knowledge that lifestyle is inversely correlated with disease.

So, how about we:

• "eat-our-greens", as my mother still advises
• demand EHR and EMR systems from our health care providers that seamlessly share data
• wear down the various surfaces at the local parks and recreation facilities with our exercise routines

That way we'll leave our hospitals free and appropriately funded for true emergencies.


Ernest A. James


President & CEO
Regal Informatics Inc.

e-Health -- it's time to decide!

Nothing brings home the saying "There's nothing new under the sun" better than realizing your so-called novel and brilliant idea has been in action for some time.
Such was the case this last weekend with regards to a PBS documentary pertaining to health care in some areas of the U.S., such as Washington State.


To set the scene for the above, you may recall from my previous blogs that I'm a die-hard advocate for LHINs managing their health care providers in terms of availability, remuneration, efficiency and the like.
Well, there I was doing the relaxation thing last Saturday when the TV announcer stated: "Coming up next, a discussion on health care in the US" -- you know I had to have a look-see, and it was very impressive indeed!


Basically, the documentary profiled companies such as Group Health Cooperative whose business model is firmly centred around the patient; here are some examples:

• EMR technology is the de facto method used to store and manage patient data
• all health care providers (HCPs) are salaried
• all HCPs are housed under one roof
• all patients have the same Internet access to their records as HCPs
• drug company reps have one single point of contact into the organization -- the latter is responsible to vet the suitability of all new pharmaceutical products

I was pleasantly surprised to see that my idea has already been proven -- which ties this discussion into a couple of items that have been prominent in the news recently here in Ontario, namely: the Provincial budget and the Drummond Report (DR).
Although we keep hearing the "they advise, we decide" comments from Premier McGuinty and his team, I feel residents of Ontario are cognizant of the fact that the biggest cuts/savings must come from the big-ticket items such as health care.
No doubt the process will be painful -- in fact recent events at the The Scarborough Hospital  (TSH) attest to that, for example:

• lay-off news: registered nurses being laid off
• consolidation news: The Scarborough Hospital considers an alliance and the LHIN's reaction

One could posit that TSH won't be the only hospital trying to reduce personnel costs or forge alliances in light of the DR -- they may just be a little ahead of the curve!

The above-mentioned TV program offers options to our Government officials -- in fact, the hospital executives interviewed have gone on record stating that savings of up to 30% have been realized.

Surely that's worth investigating, at least!

Ernest A. James


President & CEO
Regal Informatics Inc.

e-Health -- who's sneaking a peek?

Winter fails to show up in Ontario

Staring out across the park and wondering whatever happened to winter, I was gently brought back to the task at hand when a couple of recent media articles flashed across my mind -- they had me wondering who's been reading this blog!
For example one of the dailies, The Star, recently reported on a speech at the Toronto Board of Trade by the Minister of Health, Deb Matthews, where she articulated her plans for future relationships between doctors and their respective LHINs.
The paragraph that caught my eye states:

"...Matthews will place the provinces’ 200 family health teams under the control of Ontario’s 14 local health integration networks (LHINs), the regional authorities that oversee the system."

I've long been an advocate of the above (see previous article here), and even though Ms. Matthews hasn't gone all the way to make doctors employees of their respective LHINs, I feel this is a great start with respect to their availability, manageability and accountability.

I also mentioned rewarding doctors based on their performance, and sure enough, an on-line magazine article containing that same idea shows up in my inbox a few weeks later!
Although based on the US healthcare system, one could argue it's still applicable here in Ontario; the gist of the article revolves around the fact that 20%-30% of spending is wasted because of non-coordinated care; it continues by stating that one plan the Centres for Medicare and Medicaid Services (CMS) has to reduce the above:

"... is to replace the pay-for-service approach to reimbursing Medicare providers with an approach that has a significant performance element, whereby providers are rewarded for showing improvements in care.
Pay for performance requires that providers be able to prove they’ve improved patient outcomes in a range of areas."

After reading the above, I was thinking that any-time soon, some media giant such as the New York Times or The Star will be calling to discuss syndication -- after all, people must be reading my stuff -- all this blogging about EHRs, EMRs, and PHRs, may have finally begun to take root!

Well, I'm still waiting -- perhaps it was just plain coincidence, or due to the fact that "great minds think alike", or ...

What's your take?

Until next time, stay healthy and start your preparations for Spring -- it's on our doorstep!


Ernest A. James

President & CEO
Regal Informatics Inc.

e-Health -- you make the call

There I was, working away trying to reduce the size of my burgeoning inbox, when something from my LHIN caught my eye; it was a link to a document from the MoH entitled "Top 10 Tips To Avoid Catching The Flu".
With a view towards staying healthy, especially throughout the winter season, I enthusiastically clicked on the link, only to recoil at what I was reading.

Now, to avoid any misunderstanding, I am in no way averse to the MoH trumpeting the efficacy of the flu shot -- as a frequent reader of the well-respected Jon Barron newsletter, I've learnt to temper my feelings towards it, if only somewhat.
For example, in the above publication and under the heading "3. They are totally ineffective -- again, not necessarily", Mr. Barron notes:

"Even the flu vaccine, which may have only a marginal ability to prevent the flu, probably plays a significant role in lessening the intensity of the flu if you do get it. If you are very old or have a compromised immune system, this may be enough of a difference to save your life."

So, no -- my concern is only with the shameless promotion that's apparently being done here.

Let's take a look at this list -- as you can see, the first tip definitively states that the flu shot is "the best way to avoid the flu" -- this implies that the list is in decreasing order of importance/effectiveness -- no problem so far.
It then goes on to enumerate a number of other things you should do to minimize your chances of catching the flu.
What really made me reach for my glasses however, was the fact that tip #9 states: "Eat well, exercise and get enough rest."


But it doesn't stop there! Tip #10 serves to convince and impress upon you that none of the previous 8 tips is that important -- and that the flu shot is everything!
Notwithstanding the fact that eating well, exercising and resting has been a proven strategy throughout the annals of human existence and that the flu shot doesn't even register, I find this document to be an insult to the intelligence of its readers.
Personally, the MoH should apologise and re-issue this document with the following changes:

• tip #10 should be removed
• tips #9 and #1 should have their places reversed

However, from a realistic and impartial viewpoint, the document should simply be re-issued with tips 1 through 9 in alphabetic order, leaving the decision with the reader as to how best to proceed.

I'm firmly of the opinion that the embodiment of good health is ably expressed by tip #9, my friends -- managed of course by a decent EMR or PHR system.

To your continued good health!


Ernest A. James

President & CEO
Regal Informatics Inc.

e-Health -- part III, a disruptive idea

During my recent introduction to the patient flow process at the local hospital, I must admit to being impressed with one thing -- the fact that each patient is assigned to a team of professionals which includes a social worker, physiotherapist, community care representative, doctor, etc.

This begs the question: why is this experience only available in a hospital setting?
I was always amazed at the fact when I attended LHIN meetings that they were only concerned with the operation of the hospitals for the most part, as if doctors were some dangling appendage that automatically takes care of itself.
The situation became even more puzzling after I learnt that the physician community is in fact second only to hospitals in terms of representation in the healthcare budget (see article).

I'm thinking it's time for some disruption -- you see I believe in the concept that states: you can't manage what you don't measure; here's what I'm thinking could work in some form:

• require all doctors to become employees of their respective LHINs, allowing them to earn a guaranteed annual income
• have 24/7 clinics -- just imagine if police stations had the same hours as clinics and you had to report to a jail/prison for any "after hours" incidents
• hold doctors accountable for metrics not limited to:

1. patient quality of life
2. number of drug prescriptions
3. diagnostic tests 
4. use of technology
5. use of nutrition and fitness professionals

• handsomely reward ( over and above their annual salary) those who demonstrate a positive difference 
• continually encourage those who don't
• allow the naysayers to opt-out and go private; however, they'll have no access to the Ministry of Health (MoH) billing system -- their patients will have to deal with government insurance on an individual basis

It struck me that as an employee of an Information Technology company operating in the Greater Toronto Area, the annual review was one tool management used to ensure the ongoing viability of the company; these sessions included a process whereby you were measured in terms of how well you managed your goals that were set the previous year, and the outcome was a big factor in your earning potential (and sometimes your future potential with the company).
Why are we not using a similar process in our LHIN organizations?

Past experience has shown that politicians are averse to risking their popularity, placing the onus instead on some high-profile businessperson to make the tough calls, similar to the ones outlined above -- it'll therefore be interesting to read the Drummond report healthcare recommendations in the coming weeks.

Finally, as this is the last article for the year, I'd like to wish you a happy holiday season and the best of health for the coming year.


Ernest A. James

President & CEO
Regal Informatics Inc.

e-Health -- it really hits home, part deux

As I was suggesting last time, I continue to feel we have a huge opportunity to remove some of the inefficiencies from our healthcare system.
I was totally unprepared for the "Healthcare in Ontario 101" experience over the past few weeks -- however, two things in particular caught my eye, namely:

• the amount of paperwork that must flow through on a daily basis
• the flawed aspiration of one hospital to deal with the above

This monster reared its ugly head when my mother was hospitalized, discharged and re-admitted on the same day -- I marveled at the amount of paperwork being shuffled between the hospital's triage and registration departments.
I also came across an article stating that The Scarborough Hospital (TSH) was planning to implement an automated work flow system (note that the link gives a summary, but registration is required to access the full report).
My immediate reaction was:

• is this a realistic plan?
• what about the other hospitals in the LHIN? Should they not be doing something similar?
• how is TSH planning to pay for implementation and maintenance, whether in-house or outsourced? 
• has TSH seen the recent prognostication for the future of our healthcare system in Canada?

All this brought back to my mind a suggestion from a previous article, namely: let the LHINs centralize the financial and IT systems for their hospitals!
No single hospital has (or can ever hope to get in the near future) enough funding to rip/replace their current setup, and still do a half-decent job of providing healthcare -- so why not?

There are many advantages that could result, namely (and certainly not limited to):

• a centralized financial accounting system -- the capability to monitor the LHIN's "health" in real-time -- forget this "monthly updates" stuff
• implementation of state-of-the-art inter-operable EHR systems -- an "iPad in every provider's pocket", so to speak
• centralized data management and recovery
• the capability to deep-dive into the voluminous amounts of data collected daily, to spot trends, issues etc., within their respective hospitals and communities
• huge volume discounts on purchases
• internally generated cash-flow as a result of consolidation
• the capability to interact electronically with its community

I hope I live to see the day!

Finally, in part 3, I'd like to discuss the one thing that I feel must happen if we're to stave off privatization of our healthcare systems.

Remember, good health is everything -- take care of yours!

Ernest A. James

President & CEO
Regal Informatics Inc.