e-Health -- security unplugged

Up until a few months ago, I was firmly of the opinion that clinicians should be doing what they do best, i.e. taking care of their patients; they should not be concerned with the complexities of an Electronic Medical Record (EMR) system's implementation and maintenance.
But before I go any further, let's review the 2 main implementation models:

1> Local Server -- this is where the entire system (hardware and software) is installed in the practice; the doctor(s) is(are) totally responsible for its operation, maintenance, security etc.

2> Application Service Provider (ASP) -- this is where clinic personnel simply use a browser to securely connect to a server typically hosted in a Ministry of Health facility; a vendor such as xwave or Nightingale is responsible for its operation, maintenance etc.; of course, perpetual monthly fees are involved

The ASP model has been my preference because of the hands-off approach; however, I've always wondered why the Local Server option has consistently dominated the vendor certification list at OntarioMD (https://www.emradvisor.ca/compare) -- clarity came a few months ago.
You see, I had the opportunity to attend a seminar that showcased an up-and-coming EMR product called OSCAR; seeing that the implementation model was also of the Local Server variety, I pondered aloud as to why any physician would want to take on the headache of managing such a system!

The retort I got still has me thinking why I ever preferred the ASP model to begin with; the gentleman who overheard me, made these 2 comments:

1> think about the person(s) who you've always trusted with your medical data
2> think about the arrangement whereby present/future governments and/or the various companies have access to a goldmine of a database potentially containing the medical records of millions of Ontarians

I must admit that the above has helped to change my way of thinking and the Local Server option has now become a no-brainer; with the ASP model, the vendor is in control of the collection and storage of patient data and although I have no security issues with the flow between clinic and the hosting facility, I have a few concerns, namely:

1> since companies on a whole exist solely to make money for their shareholders, having a database idly sitting by does not make good business sense -- heck, as an EMR vendor, my company would be chomping at the bit to anonymize the data and sell it for research or other marketing purposes on a subscription basis (within the confines of applicable laws, of course); could governments also not try to justify this as a potential revenue stream
2> what happens to/who owns the database should the vendor go belly-up; and whilst all this is being sorted out, what are the implications for the continued operation of the practice
3> databases containing such large amounts of personal information always will be targets for the unscrupulous -- what would be the implications of a breach

Agencies such as eHealth Ontario and Canada Health Infoway should be concerned with putting the plumbing and standards in place to facilitate the secure sharing of data between provider facilities (be it an ambulance, a hospital or a doctor's office) as opposed to expending resources toward the creation/maintenance of medical databases.
Dianne Daniel in her article "Patients want providers to use EHRs, and expect privacy protection", suggests that there's a new generation of tech savvy patients out there who not only want their records to be ubiquitous, but want it done in a highly secure and confidential manner (Canadian Healthcare Technology, Focus on Security, October 2009, p14).
The only way I can become comfortable with the ASP model again is if the data leaves my doctor's office encrypted with me having exclusive ownership of the key -- that way, we can decide which parts of my record gets shared and with whom.

With regards to the afore-mentioned overhead involved for doctors to run their own systems -- I guess security comes with a price!

In the meantime, your mission, should you choose to accept it, would be to find out whether your doctor uses the Local Server or ASP model and get a dialogue going with regards to the above.

After all, it's your data!

In the meantime, I'm betting we'll get our first snow storm during the week of December 13th -- what sayest thou?
'Till next time, watch  how you go!

Ernest A. James

President/CEO
Regal Informatics Inc.

e-Health -- why we need the VAT

Fellow e-Healthers, I'm very concerned -- you see, our Provincial (Ontario) budget recently made a 911 call for help and was taken to wherever budgets go for ER care.
A preliminary diagnosis has been made and the problem appears to be a herniation/rupture in the feeder artery to the various ministries -- folks, money is flying everywhere.
Consultants like Peter are rubbing their hands with glee, but so is Paul the banker since he's getting his money back guaranteed, with interest!

Of course, akin to getting an H1N1 vaccine shot these days, we'll have to line up and wait in the snow, ice and rain for a definitive prognosis and course of treatment, but based on the state of our economy, it's definitely gonna be painful over the years to come; our Finance Surgeon (I mean, Minister) will no doubt have to slash and burn to repair the damage.

However, despite the pending doom and gloom, I see some means of mitigating the above -- I think this time the pharmaceutical companies (aka Big Pharma) can help us -- let me explain...

You see, had this been an election, the results would have been catastrophic for the losers; I'm referring here to the current H1N1 vaccination campaign from the perspective of our various levels of Government versus those opposed to it (companies/health advocates such as http://articles.mercola.com/sites/articles/archive/2009/11/03/What-We-Have-Learned-About-the-Great-Swine-Flu-Pandemic.aspx, http://www.naturalnews.com/027292_vaccines_influenza_vaccination.html and http://www.davidicke.com/content/view/25191 amongst others).

It just amazes me that in spite of all the rhetoric used by the above "don't-do-it" camps, the majority of the population has still seen it appropriate to line up in droves for hours on end to get vaccinated, even in inclement weather.
The populace has embraced the promised efficacy of the vaccine which has created a huge demand for the product http://www.healthzone.ca/health/newsfeatures/swineflu/article/717842--hundreds-queue-for-h1n1-flu-shots, which in turn has created a shortage http://www.healthzone.ca/health/newsfeatures/swineflu/article/718484--temporary-h1n1-vaccine-shortage-looms; so in effect, Big Pharma has yet another winner on its hands!

Whether we agree or not, the fact is that flu vaccines have become a staple; and what else do you do with a staple like alcohol or fuel but tax it at will!
But the kicker behind my suggestion is that the Government should tax vaccine ingredients such as squalene, mercury and formaldehyde (see http://www.novaccine.com/specific-vaccines/vaccine.asp?v_id=16) so we get a piece of the profits that Big Pharma will proudly announce at their year-end; that way we can at least help reduce the up-coming cost pressures on our various e-Health initiatives and hospital budgets.

So, what would this tax be called? Funny you should ask! As a former United Kingdom resident, "Value Added Tax" (VAT) comes to mind -- after all, it's a well-recognized concept!
To differentiate it from a consumer-oriented tax however, it's official name should be the "Vaccine Adjuvant Tax".

I ran this idea by a friend of mine who promptly responded by singing the song "Dreamer, you stupid little dreamer;..." by Supertramp.
I reluctantly accepted the label, but immediately challenged her to help me understand the following, namely:

• why would our Government recommend we get vaccinated, then when we respond, we have to queue up in the rain to get the vaccine
• why would our Government recommend medication that has no clinical trials to back up its efficacy
• why would our Government protect any vaccine manufacturer from lawsuits arising from faulty product (see: http://www.healthzone.ca/health/newsfeatures/columnsandblogs/article/719140--walkom-why-shot-may-not-be-as-safe-as-claimed) 
• why should our Government do all of the above for Big Pharma and all we get is stabbed in the arm (at best) and our health care budget stiffed

To my way of thinking, since our Government has done such exemplary marketing work, its citizenry should also benefit from the huge profits we know will be coming.

What are your thoughts? Am I a really dreaming?

As the cold season gets going, look after your health and remember to watch where you put that rake as you clean up the leaves!

Ernest A. James

President/CEO
Regal Informatics Inc.
www.regalinformatics.com

e-Health -- organizationally speaking

I'm often asked who the major players are in the eHealth system in Ontario, so I'd like to take this opportunity to discuss it with a view towards having any misunderstandings on my part, corrected.

OK, let's start the discussion with a Government agency called Canada Health Infoway (CHI) -- the latter is funded by the Federal Government and has a mandate to manage the roll-out of the Electronic Health Record (EHR) Canada-wide.
CHI delegates the work and funding to each Province -- here in Ontario, we're slated to have a fully-functioning EHR for everyone by 2015; current news articles tend to cast some doubt over the latter, but nevertheless, this is the current projection.
See http://www.infoway-inforoute.ca/lang-en for more details.

The Ministry of Health and Long Term Care (MOHLTC) is of course our Provincial ministry responsible for all things related to public health care and is included because it also funds eHealth initiatives through the various agencies discussed below; this ministry gets the bulk of its funding from Federal Government transfers and our Provincial tax dollars.
See http://www.health.gov.on.ca/en/default.aspx for more details.

eHealth Ontario could perhaps be regarded as CHI's arm in Ontario -- basically their mandate is to create the Information Technology (IT) infrastructure on which the EHR will be built; for example, it's all fine and good to have Electronic Medical Records (EMRs) installed in care provider facilities (such as doctors' offices, hospitals and nursing homes amongst others), but if they cannot electronically share this information, not much progress from our current paper-based records will have been made.
Hence, eHealth Ontario is working to implement a secure data communication network for authorized medical facilities.
See http://www.ehealthontario.on.ca/ for more details.

Local Health Integration Networks (LHINs) also play a role in eHealth, but they tend to focus on managing community health care. Funded from the Provincial budget, initiatives include IT projects that help to transform major health care providers such as hospitals and long term care facilities.
See http://www.lhins.on.ca/home.aspx?LangType=4105 for more details.

OntarioMD is the IT resource for physicians in Ontario, hence it plays a key role in the implementation of the EMR which in turn is a component of the EHR.
Funded by the Ontario Medical Association (OMA) and the MOHLTC, you'll find OntarioMD involved in such projects as helping physicians navigate the maze of the EMR implementation process, or certifying EMR vendors' software offerings.
See http://www.ontariomd.ca/ for more details.

Of course the above is just a basic overview -- as with real life, there are no crystal clear delineations between  eHealth organizations since one could just as easily find CHI or eHealth Ontario funding a special project with OntarioMD, for instance.

So there -- I've dared to document what I know; now it's your turn! What do you think -- have I missed/mis-represented anything?
Please -- feel free to comment.

Contest

You're still encouraged to guess where the above picture was taken -- please check here for some notes and rules.

Hint: What prefixes "land" goes with a shirt

Month: October

Yikes, Daylight Savings Time is coming to an end! Stay aware as it becomes darker when you leave/get back home.

Ernest A. James

President/CEO

Regal Informatics Inc.

www.regalinformatics.com

e-Health -- Mother Nature sends a message...

It was a dark and stormy night with a howling wind that had the rain beating mercilessly on the leaves of bent-over tree branches.

For myself, the only immediate concern was for things to settle down so I could catch one of my favorite PBS (Public Television) shows, "Doc Martin".

By 8:30 p.m., things had not improved much so I decided to dig out my battery-powered radio only to find out we were under a tornado watch and that quite a few places in the Province had just experienced a small taste of Mother Nature's power; I silently wished the residents of the affected areas well and decided that sleep would be the best option at this point.

I was totally unprepared for the images that were being shown on most Canadian TV news channels the following morning; for example, scenes from neighborhoods in the City of Vaughan (Ontario) to a lesser degree, were somewhat reminiscent of my experience with the aftermath of the passage of hurricane Hugo over the island of Montserrat (West Indies) in 1989; residents were standing in the streets looking at their homes with their roofs ripped off and the contents strewn over the surrounding area, in utter disbelief; how could this have happened in their neighborhood?

During my usual morning walk, it struck me that there was also a mention of a medical building having its roof ripped off and of course, with my interest in e-Health, my mind began to wander/wonder...

Considering the extremes of weather we experience in Canada (I read recently that as a country, we are the second-most prone to tornadoes in the world -- "http://www.680news.com/news/headlines/more.jsp?content=20090821_184551_6288"), should I not be more proactive in ensuring that:

• copies of my medical records are safely stored at an alternate site
• I begin looking into setting up a Personal Health Record (PHR) system
• I'm aware of the procedure to be followed should the unthinkable occur to my doctor's clinic

I have the first point covered in that my doctor uses an Electronic Medical Record (EMR) system and I have no doubt that it's well implemented in terms of off-site backups etc., but to the second/third, these have not been high on my list of priorities!

Like many of you, I've had the same physician for decades -- sure nothing has ever happened, but that tornado watch of August 20th, 2009 should be a wake-up call for us all!

I'm gonna initiate a discussion with my doctor next visit -- perhaps you should too!

Contest

You're still encouraged to guess where the above picture was taken -- please check here for some notes and rules.

Hint: Over the pond

Month: September

With apologies to Winter lovers, here's to Fall lasting through the end of the year.

Ernest A. James

President/CEO

Regal Informatics Inc.

www.regalinformatics.com

eHealth: Go tell it on the mountains...

Between the bouts of pouring rain and noise from construction workers' tools, my mind was gently meandering as I tried to brighten the mood of an otherwise dull day by imagining on which side of the over-flowing stream that runs by my building, were they trying to build an ark!

Suddenly I was jerked back to reality by a Canadian Broadcasting Corp. (CBC) television news article -- one of our health officials was trying her best to explain that due to the urgent need of a vaccine for the H1N1 virus, not only was there a strong possibility of rationing, but only limited efficacy testing can be done prior to the upcoming so-called "flu season".

Thoughts of the Thalidomide debacle rushed through my mind and I found myself having to take a small glass of "something" to calm my nerves.

After listening intently, I asked myself (quietly, of course): what rational human being would agree to take a vaccine (in whatever form) that had not been tested for a reasonable amount of time (whatever that may be)? The only answer I could come up with is: no one!

To my mind, the problem here is one of awareness and lack of information; Internet articles written by well-respected doctors and nutritionists postulate that the human body knows best as to how to look after itself, so a regimen of good nutrition, personal hygiene, knowledge of your health status, exercise and regular sleep should serve anyone reasonably well.

The article entitled: "Ten Things You're Not Supposed to Know about the Swine Flu Vaccine" should be mandatory reading for everyone you know/care about, so please make sure you spread the word -- registration may be required, but believe me, it's well worth the effort; I especially like reason #10.

I will continue to advocate that Electronic Medical Record (EMR)/Personal Health Record (PHR) systems that show you where you've been (and suggest in which direction you're heading) along with the above-noted habits are basically sufficient -- anything else would be akin to knocking on a door labelled "Trouble"!

Contest

I see we've disappointed the library once more -- no one has identified the country where the picture in my last article was taken, so I was able to return the book without incurring any overdue fines.

For this month, I've found yet another book, and this one's entitled: "The scalpel and the soul" by Allan J. Hamilton, M.D., FACS; I guarantee you'll never again think the same way about the human body; read it if you dare!

So, let's see if you can correctly guess where the above picture was taken -- please check last May's article for the rules.

Hint: Look down under!

Month: August

To your continued good health.

Ernest A. James

President/CEO

Regal Informatics Inc.

e-Health: do as I ..., not as I ...

In light of the current alleged shenanigans at e-Health Ontario, I was doing some internalizing stuff and noticed discrepancies in my own organization -- I was preaching the EMR/EHR message but was still visiting a physician with a paper practice; you see, my doctor had moved to Toronto and I felt I had little option but to go with whoever was accepting patients locally.

What a cop-out -- I almost went to the media to expose the situation but thought the better of it since the public at large would surely call for my resignation!

So quickly and quietly before word got out, I did the right thing and made an appointment to see my former doctor who's practice had long been "EMR'd".

The experience was better than I had anticipated -- you simply announced your arrival and waited for the doctor to come get you -- something vastly different from the usual:

• presenting your health card
• sitting in the waiting room and reading 10-year old magazines until your file was located
• moving to the examining room with your file in the door slot, waiting and wondering what on earth those long tubes and gloves were used for

Instead, my doctor came out and took me to her examining room where I experienced the power of an EMR system in all its glory.

Since I had elected not to move with her as a patient, it appears my chart had not been scanned into the system, but once I had made an appointment, the basics were loaded.

We spent the encounter briefly discussing any recent health problems etc. and reviewing my EMR -- I must admit that in a very short time I was both amazed and impressed with its capabilities such as:

• prescriptions at the click of the mouse
• the capability to view historical data, both textual and graphical
• the capability for any physician (at least within the Family Health Team environment) to access my chart remotely

Rumour has it that my doctor will be moving back to her old office within the next few months so I'll be looking forward to really getting into the nitty-gritty of this EMR/EHR/PHR stuff.

Well, it seems nobody won the book prize from last month, so it looks like I'll have to renew the loan at my local library!

Please check last month's post for the rules.

Hint: You can't get there from New York!

Month: July

Good luck and remember to go boldly forth reducing the mosquito population, one slap at a time!

Ernest A. James

President/CEO

Regal Informatics Inc.

Hey guys -- how's your e-Health?

Partly as a result of all that moisture we've been having, the view from my office window is inspiring -- there's a huge park directly ahead that's been manicured for the local soccer teams, the trees all around are green and majestic, gracefully camouflaging the houses and their beautiful gardens.

Everything looks so wonderfully healthy -- until I glance down! Winter's not been kind in the fitness department -- seems like the pounds have a way of sneaking up on you when you're otherwise engaged!

If you're like me, you probably wish there was a way to constantly/automatically monitor your health so that you'd be aware of what's going on -- that way, surprises come Spring/Summer or during a health check-up are kept to a minimum; heck, even if you're super-fit, knowledge can still be a powerful tool!

Well, wish no longer -- things are a-changing in the e-Health arena as we speak; remember in one of my earlier articles I mentioned Personal Health Records (PHRs)? From my perspective, this could be the next big wave in health care.

Let's set the scene; notice how you hardly have time these days to ask your doctor "how's the wife/husband and kids" before they leave the exam room for the next "patient"? Well, get used to it -- business pressures are going to make the image of your doctor even more of a blur as they dash from room to room.

So this means your health is gonna become much more of your responsibility -- understand that I'm advocating prevention rather than intervention here.

Pedometers, blood pressure/glucose monitors are just a few examples of devices that will allow you to upload measurements to a "Health Portal" such as Microsoft's HealthVault (http://www.cbc.ca/health/story/2009/05/06/tech-telus-health-space-microsoft-electronic-health-records.html) or Google's Google Health (http://www.google.com/intl/en-US/health/about/index.html).

Basically these web sites allow you to securely store your health data (meds, measurements etc.), offer you the option of sharing the latter and come with various built-in health management tools.

Also, stay tuned for upcoming offerings from Wal Mart!

OK, so say you're hypertensive and your doctor has you on the appropriate meds; you've had an epiphany and decide once and for all you're gonna beat this weight thing and at a minimum, have the medication reduced.

You're also computer literate (and moved past the security issues), so you decide to try Telus' HealthVault; you buy a pedometer and a blood pressure monitor, walk/pump weights on alternate days then upload your exercise/blood pressure/weight data to the 'Vault.

On a daily/weekly basis, you use one of the tools to show you a picture of what's going on and soon you notice your blood pressure/weight are steadily decreasing.

Next doctor's visit, he's so impressed that he's considering reducing the meds and promising you to start working on that paunch he's developing!

Picture the functionality of a PHR system as somewhat similar to an Excel spreadsheet -- a picture is worth...

You spend your hard-earned dollars on so many things these days that you can't really appreciate where the money's going until you press the "graph" key and notice that you're spending way, way too much on shoes, or if you're like me, on chocolate-covered almonds!

To wrap up, all I'm saying is that with the ever-increasing cost pressures on health care, our quality of life will soon become directly related to the effort we put into maintaining it.

Now, as I promised, I'm starting a "where-am-I" contest; if you can guess where the above picture (double-click it if you need a better resolution) was taken, I will arrange to send you something I hope you'll like -- this month, it's the book "No matter what" by Lisa Nichols.

A hint and the month the blog pertains to is provided below.

The rules are simple, namely:

1> you were not at the location when the picture was taken

2> you must reply in a comment to the blog -- first correct or most accurate (e.g. Toronto as opposed to Ontario) wins

3> you were not a previous winner in the past 6 months

4> contest closes at 23:59 (EST/EDT) on the last day of the month of the blog's publication

4> prize(s) is(are) carried forward if there was no winner for the month -- the result will also be announced as a comment to the blog

5> ...and of course, Management reserves the right to make the final decision

Hint: not in Canada

Month: June

Good luck and remember to go boldly forth looking after your health and beautifying your neighborhood!

Ernest A. James

President/CEO

Regal Informatics Inc.

e-Health security -- it depends on you too!

Hello everyone,

This month's topic is such a meaty one, I'm gonna bypass the formalities and just jump right in, concentrating on the unauthorized access to medical files; we'll cover the so-called "acts of God" at another time.

Firstly, a couple of questions: do you use Internet banking? Do you interact with the Canada Revenue Agency (CRA) for such purposes as "Netfiling" your taxes?

Well, before you answer, I'd like to comment that if you're like the general population, these tools are lifesavers -- just imagine you now have the option/capability to file your taxes dressed in your jammies with your favorite cup of brew at 23:30 on April 29th/30th -- no pressure!
Or, you're on vacation in St. Kitts (West Indies) and there's a bill you forgot to pay before you left home; if you're like me and hate paying interest unless absolutely necessary, you'll soon be making your way to an Internet kiosk...

Many people I've spoken to with regards to e-Health security express a concern that hackers may be able to access their medical files; personally, if someone is able to see that I have a million dollars in my bank account, that wouldn't bother me much since knowing doesn't make him/her a better/richer person; similarly, if someone was to get access to my health file and learn that I had a serious itch that required monthly prescription renewals, the same would apply.

What would keep me up at nights would be learning that hackers had the capability to dip into my money, or alter my prescriptions to the detriment of my health.

However, I can appreciate that privacy is everything to some, but in reality, is the current paper file methodology we use today any more secure? I would argue not!

Let's explore this:

say for example, Dr. X has a very busy practise; it's summer time and a couple of med students or other appropriate part-timers are hired on to help.
What's to prevent the latter from occasionally taking a peek at your file? How would you know if they did? Suppose they knew you personally?

Fast forward to e-Health -- Dr. X has implemented an Electronic Medical Record (EMR) system and as part of their employment contract, staff are required to access patients' files on a "need-to-know" basis only; with the proper controls in place, an auditor should be able to produce a report showing who did what and when (remember when the IRS fired employees for snooping? =>: http://www.wired.com/threatlevel/2008/05/five-irs-employ/) -- try that with paper records!

In reality, nothing's 100% secure, however, laws are in place that can serve to punish those who circumvent the privacy of others for their own selfish purposes. The problem with our current paper system is that it's virtually impossible to police these laws!

As I've stated previously, if our EMR/EHR systems are implemented with the same type of rock-solid security that we see in our banking and the various Government web sites, we should be well on our way towards a much more efficient health system.

Well, that's it for now; next month we'll be discussing the ways that EMR/EHR systems are becoming personalized (Personal Health Record -- PHR) -- you'll be amazed at what's in store!
Also, to perk things up a bit, I'll be introducing a "where-am-I" picture campaign; if you can correctly guess where the blog picture was taken, I'll send you a prize.

So until then, go boldly forth, remembering to stay aware of your surroundings.

Ernest A. James

President/CEO
Regal Informatics Inc.

e-Health trumps a seemingly good idea

In a way, I'm glad to see the back of March; you see, sometime during the fourth week, I picked up a virus that left me both with a distaste for food and a renewed appreciation for the utility of the bathroom.

By the end of the month I was feeling much better after following a chicken soup regimen for a couple of days, but had a real concern for my electrolyte levels especially after the scales showed I was upwards of 7 pounds lighter.

Thinking about my recovery options in the shower one morning, I was overcome with an epiphany for a sure-fire business idea, namely to:

• cultivate a stomach virus
• offer it to customers who need to lose weight quickly for an upcoming event (I'm sure you can relate to the "oh-mi-gosh-I-have-to-lose-weight-this-week-so-I-can-fit-into-this-dress/suit-for-the-wedding-on-Saturday" type of a comment), medically supervised, of course
• guarantee results
• offer a free colonoscopy on completion of the "treatment" (this would be an ideal time since your colon will never be in a more pristine condition)

Unfortunately, after hearing the reaction from some of my friends, I had to drop this idea faster than I could run to the bathroom during the first day of my illness.

So, here we are again discussing my "other" favorite topic, e-Health.

I'd like to begin by congratulating the Oshawa Clinic Group for their decision to implement an Electronic Medical Record (EMR) system (This Week, March 26th, 2009, p:10); I'm rather thrilled at this development because it's the first local validation of what I've been discussing all along.

For those unfamiliar with the group, it represents the Oshawa, Courtice and Taunton clinics in the Durham Region -- the planned EMR system is said to involve upwards of 1/2 million records.

Hopefully, this will be a beacon for other doctors in the Region re their decision-making efforts for their practice.

The second encouraging piece of news comes from our friends south of the border in that the Obama Administration has decided to implement an EMR system for military personnel that will stay with them for life -- Google the term: Obama + e-Health records for vets and read to your heart's content if you need additional information.

The significance of the above can be seen from the fact that this will probably rank up there with some of the largest EMR systems implementation and will in all probability be used to trail blaze the proposed health care changes that are part/parcel of the stimulus package.

Also, you cannot implement a system of this size without setting interoperability standards --something we desperately need in the health industry.

Of course, all these changes are bringing out the best in the privacy pundits who are now proclaiming the end of the little medical privacy we had.

I'd like to add my $0.02, but in the interest of brevity, I'll wait for another issue.

In the meantime go boldly forth, but watch your back as you tend to your garden!

Now, where did I put that Petri dish, I mean, the phone number for the Oshawa Clinic Group...

Ernest A. James

Regal Informatics Inc.

e-Health in Ontario -- is it real, or is it...?

The homeowners I greet on my daily jaunt around the neighborhood are such a great bunch; one bright and very cold but sunny Saturday morning, one of them remarked to the effect that it was a good job I had my hat on, otherwise I could suffer a sunstroke!
Last month during a snowstorm, another was digging out his vehicle, saw me coming and exclaimed somewhat frustratingly: "... don't you just hate these sandstorms!"

I brought those two examples up to highlight how easy it is to bury our heads in the proverbial sand with regards to anything, even e-Health; regarding the latter, I've had many comments to the effect that:

• there's no way the Government could put our health records on the Internet -- the privacy/security issues are insurmountable
• the system's working reasonably well right now -- many countries admire us for what we have
  
• nobody's gonna be interested in accessing their medical records from home
• this is just another instance of "Big Brother" trying to control us
  

There's a saying to the effect that all truths traverse 3 stages -- ridicule, opposition, and finally acceptance. Hopefully, information from my previous articles along with material from the various web sites included have been helpful in moving us to the acceptance stage.
Granted, those who voice opposition do have a right, but based on the life/cost-saving potential of e-Health, we should be using these concerns to help those responsible get things right as opposed to delaying implementation.

That said, the number one thing I feel we can do is to discuss it with our health providers during our next office visit -- s/he is probably well aware of e-Health and is in a good position to give an honest opinion based on their issues/concerns.

Secondly, we can keep abreast of what's happening locally, provincially and federally -- a good web site to track the Canada-wide progress of e-Health can be found here.

Thirdly, we can support our Local Health Integration Network (LHIN); the Government has divided Ontario into 14 areas (LHINs) and downloaded the health care funding and accountability to them; check out the web site for details about your specific LHIN here;
My LHIN (Durham Region) is called Central East and I've had the opportunity to attend one of their recent board meetings -- I believe these are held monthly, are open to the public and managed very professionally.
I think you'll get a good feel for the complexity of issues pertaining to both your LHIN and the system as a whole.

Fourthly, I feel that e-Health has the potential to revolutionize our health care system -- unfortunately revolutions never come cheap.
Apart from Canada, countries such as Great Britain, France, United States, Australia and Japan (amongst others) are all struggling with the funding issue; we need to get in touch with our politicians and make them aware of the fact that they have a constituency that's well-versed in e-Health, and that we expect them to keep the latter as one of their funding priorities.

Lastly, let's discuss it amongst family/friends; I've been pleasantly surprised by the number of people who've told me their doctor no longer uses paper records -- I'm also pretty confident that acceptance by the younger Facebook/Twitter-aware generation will be enthusiastic at a minimum.

Admittedly, some short-term pain is involved, but longer term we'll be both improving our health system and leaving something decent for the next generation.

So please, let's get involved -- after all it's our money -- better still, it's our health!

Until next time, let's go boldly forth.

Ernest A. James

President/CEO
Regal Informatics Inc.

eHealth in Ontario -- why/why not?

Well I sure hope your winter weather experience has been, at a minimum, accident-free thus far. I've been keeping track of the sun's trajectory and I'm thinking Spring's the new kid on the block -- this may appear to be counter intuitive or overly optimistic right now, but trust me, Winter's legs are both failing and flailing!

Speaking of accidents, I saved the "In the wrong hands" headline story from my copy of the January 21, 2009 "Whitby This Week" newspaper; there's a picture of a somewhat bemused gentleman who received a six-page fax of a patient's medical record from the Ajax-Pickering Hospital -- the fax recipient had no idea who the patient was!
Also, a couple of weeks ago, a friend of mine needed emergency care over the weekend; after stabilization, she was admitted and told that the hospital would be holding off on any further treatment until her doctor's office opened the following Monday -- apparently they needed her medical history to formulate the best treatment, going forward.

I picked on the above real-life examples to try and answer the "why" portion of this article -- in the case of the Ajax-Pickering hospital, the latter was apparently trying to send the patient history to a nursing home in the region; just imagine if eHealth was in action -- there would really be no need for anyone to be faxing anything anywhere since all authorized Health Providers would have on-line access to patient data; likewise, for my friend who had to be hospitalized, there would be no need to wait to get important historical information from her doctor's office.
Now, I'm in no way suggesting that anyone's health was compromised during the above events, but I'm sure you can appreciate the value-add of an EHR (see my previous articles for a discussion of the Electronic Health Record).

There are many more instances that one can perhaps list to support a case for the "why", for example:

• you are on vacation and for some reason you need emergency care or a prescription renewed -- wouldn't it be nice to know that all Health Providers involved have on-line access to your medical history? No more drug allergy reactions or illegible prescriptions!


• you alone are responsible for your health, so why not provide the tools to help you manage it, even from the comfort of your armchair?


• there's no way we can keep increasing the tax burden at the current pace for our health care systems -- Information Technology is one of the ways we can get a quick and positive jolt to the efficiency of the system

It's possible that you may have your own reasons to add to the above list, but to be fair, all is not rosy in the land of eHealth; for example:

• many people have privacy concerns about their medical records being available on the Internet


• many voice the concern re their emotional capacity to withstand the shock of finding out bad news, i.e., how would you react if you took a test and had the ability to view the results from your armchair, only to find out you had a few months at best to live?


• many prefer not to be in a position of having to explain why they'd rather not share their health information with their partners -- just imagine you're at home being cajoled with the argument "...but honey, you can see mine, why can't I see yours...?"

I freely admit to only being able to competently debate bullet number 1 (the privacy concern issue), in that banking and taxation information today is freely accessible to authorized consumers over the Internet; compared to the regular occurrences of health information privacy breaches, I've yet to learn of an instance where an account at a banking/government institution was compromised, to date; that's not to say that these systems are infallible by any means, it's just that the rigid standards that have been applied to their implementation makes the possibility minuscule -- there's no reason why the same standards cannot be applied to an eHealth system.

As to bullets 2/3, I humbly defer to the appropriately qualified personnel.

In closing, although the "ayes" seem to outnumber the "nays", I believe the cost factor will have the biggest impact in terms of eHealth implementation; in other words, it's not "if" -- rather, it's just a matter of "when". As educated consumers we need to rev up the debate on this topic -- awareness is a key factor!

Next time I'd like to tackle the implementation roadblocks to eHealth, what I feel our responsibilities are (both as patients and primary care providers) and take a quick look across the pond (at the United Kingdom) and over the border (at the United States).

I look forward to your thoughts!

Take care and watch out for that ice above your head and below your feet!

Ernest A. James

Regal Informatics Inc.

eHealth in Ontario -- a personal perspective

Well, Happy New Year everyone, and I wish you the best of health for the coming year.

Speaking of health leads me nicely into the topic for this session -- remember last time, I promised a discussion as to how I got into this whole Electronic Medical Record (EMR)/Electronic Health Record (EHR) thingy? Well, here goes...

About a couple of years ago, I was working out in my employer's unsupervised gym and someone came through the door just as I had lifted a dumbbell over my head.
Of course, curiosity got the better of me and straining to see who it was, I damaged the nerves in my neck.
Now in the interest of brevity, let's fast-forward to the point where my doctor requested an MRI -- trouble is, I found out I was claustrophobic and unable to complete the procedure.

Driving home from the hospital at 3 a.m. despondent and embarrassed, I pondered over what other people who were in a similar situation to myself (or even those who were too big to fit into the machine) did to get an MRI procedure done -- there had to be another way!
Being in the Information Technology (IT) industry, I jumped on the Internet and began my search, learning about the various types of MRIs (open-MRI/closed-MRI), and eventually underwent an open-MRI procedure in upstate New York.

During my research, I came across the term "e-Health" on the Ontario Health Insurance Plan (OHIP) web page -- I assumed that anything prefixed with an "e" had to be IT-related so I dug deeper only to realize there's a huge global industry pertaining to e-Health and that Ontario, along with every other Province in Canada, were busy implementing it.
I felt drawn to this business because of my experience in the IT industry and the possibility of having some impact on the health of my fellow-man -- of course the bills also have to be paid, but nothing would give me more satisfaction than Ontario residents being able to access their health records at home/abroad and knowing I had a hand (no matter how small) in making it all come about.

I also promised to give my understanding of what an EMR/EHR is, so here goes:

An EMR is basically a computerized record of what transpires between you and your Health Provider during a visit; for example, instead of your doctor making paper notes or writing paper prescriptions, the information is keyed into a computer that's located in the examining room. Prescriptions and lab requests/results are also handled electronically.
Typical data that may be found in an individual's EMR would include (but certainly not limited to): name, address, physical attributes, medical history, allergies, required periodic procedures (such as flu shots) etc.
This type of data would normally be kept in your Health Provider's office.

An EHR on the other hand tends to be a subset of the EMR, i.e. it would typically include information at an aggregate level, but still capable of providing enough information for other health providers such as emergency personnel if necessary.
This type of data would normally be kept at a Provincial Government establishment, or the facilities to link Health Providers would be provided by the Province.

A good distinction between the above entities is akin to the difference between Municipal and Provincial/Federal Governments; Municipalities are mainly responsible for the local level of government interaction with the individual, i.e. policing, property taxes, building codes etc.; Provincial/Federal Governments on the other are mainly responsible for those areas that affect the Province/country as a whole such as trade, border security etc.; however, they also have access to the individual if required.

Well, that's it for now -- next time we'll delve into how/when it'll all come about and what's happening abroad (especially in the U.S.).

I look forward to your comments and in the meantime, watch how you go.

Ernest A. James
Regal Informatics Inc.