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.

e-Health -- it really hits home, part 1

I was all set to pontificate on the ramifications of the election results (from an e-Health standpoint), when I was jolted back to reality about a week or so ago -- you see, my mother fell at home and had to be taken to her local hospital's Emergency Department (ED).
In spite of heightened emotions, I was still eager to check out what type of an Electronic Health Record (EHR) system the hospital used -- I must admit to my disappointment.

Let's be clear -- this discussion is process-related only and has nothing to do with the hospital staff providing the care for my mother; my sole wish is that it serves to help ratchet up the discussion for a true EHR system in this great Province of ours.

That being said, here's a blow/blow of the recent event:

• ambulance personnel arrive at my mom's place -- one of the tools they carry is a laptop; I'm intrigued -- perhaps this is the beginning of an EHR experience, I thought; no such luck -- they never even asked for a Health Card number (HCn), to the best of my recollection
• when we got to the receiving area at the Hospital, I observed them verbally describing the situation to the ED nurse who in turn, took notes
• we then had to go to the triage department where one of the things asked for was my mother's medication record (I had to apologize and explain that in the heat of the situation, that was not one of the things that came to mind)
• then it was on to the registration department where more info was requested and a stack of completed forms and labels were printed
• the latter then had to be placed in a tray at the triage department window

This isn't bad, although it could be improved, I thought as I settled down for a nap, waiting for my Mom to see a doctor.

What transpired at the end of the visit had me shaking my head in disbelief!
Following a long day and a battery of tests, the doctor finally agreed that my mother could be discharged; however, by the time we got back to her apartment, the phone rang and I was ordered to return her to the emergency department immediately -- apparently they didn't like the way the numbers from one of her tests were leaning.

My expectation was that when we arrived back at the ED, her HCn would be keyed in and she'd be seen immediately by the doctor requesting her return.
WRONG! We had to repeat the same process as when we first arrived, i.e. triage, medication requests, blood pressure checks etc., then on to registration where an even bigger stack of paper and labels had to be printed, collated and returned to the triage window.
During my protestations at the delay this was causing, I was told it was necessary due to the fact that records are expunged from the system once a patient is discharged.
Heck, one of the staffers even commented to the fact that an EHR would make things so much easier, to which I replied: "You're preaching to the choir!"

Let's place a bookmark here and discuss next time how one particular organization can drastically improve the above, whilst simultaneously contributing to the reduction of the cost of healthcare delivery, in my next article.

See you then!

Ernest A. James

President & CEO
Regal Informatics Inc.

e-Health -- changes are coming

How do I know Summer's waving goodbye? Well, there are 3 yardsticks that work for me, namely:

• people can no longer admire my legs during my morning walks -- it's now too cold to wear shorts
• kids are back at school and you begin to notice the unmarked police cars around the various school zones
• you suddenly get rattled out of your chair the Tuesday following the closing of the CNE, as the Snowbirds do a low-level fly-by in the Durham Region

Speaking of change, there's one happening right now at my local hospital: http://www.durhamregion.com/community/health/article/1072951--mri-arrives-at-ajax-pickering-hospital; from what I gather, this new MRI system is one of the best, at least in Ontario, if not Canada!
There were huge celebrations and welcoming committees for the magnet in Pickering and Ajax during the last week of August. Congrats indeed to everyone involved!

Notwithstanding the tremendous benefits of the above, I'm wondering if we shouldn't also be using our health care dollars at the front-end, i.e. for preventative health education; nothing would please me more in a few years to read that this new MRI has been under-utilized and the major reason for the latter being attributed, with utmost certainty, to healthier communities!

One can understandably tire from the constant media barrage of articles telling us stuff similar to the following:

"Hospital overcrowding is leading to patients being left on hallway stretchers in emergency departments, sometimes for more than a day... Surgeries are getting cancelled and more patients are getting hospital-acquired infections. Residents of some smaller communities have to travel further for health care because their local hospitals have been cut or closed. And outpatient clinics that provided services like physiotherapy have been shuttered."


I'm hopeful that after the upcoming Ontario elections, we'll see a much more concerted effort to put the major responsibility for quality of life squarely on the shoulders of the individual -- along with the requisite tools (such as connected PHRs, EMRs and EHRs), of course!

Martin Wiseman, the World Cancer Research Fund’s medical and scientific adviser suggests in a Toronto Star article on healthier living that:

"The real problem is not coming up with new solutions, the real problem is having the will to implement what we already know."

Before I close, I need to mention that I do value your time and thank you for the effort expended to read this blog; however, should you no longer wish to receive the notification e-mail, please take action as described at the bottom of the latter -- sure I'll be upset, but I'll get over it much more quickly if you promise to at least check out this blog occasionally.

To your good health.


Ernest A. James

President & CEO
Regal Informatics Inc.

e-Health -- dé·jà vu?

I'm sitting here looking out at the park just across from my office; the rain has been falling steadily over the past few days, and this has resulted in a healthy growth of grass.
A subcontractor had just repainted the soccer pitch boundary lines -- I could see him standing back, admiring his handiwork.
To my astonishment, as soon as the painter left, the Town's mowing machines appeared and began cutting the grass, obliterating the work just completed; this begs the following questions:

• Could the Operations department of the Town not take the time to coordinate these services (for example, having their employees electronically update a task sheet after mowing the park, which would then alert the painter to do his thing)
• Who should really pay for the painter to return -- we all know this will simply be added to taxpayers' tab

This is the type of situation that tends to raise one's ire, and allows me to segue to a recent news article:
http://www.healthzone.ca/health/newsfeatures/cancer/article/1030897--missing-packages-put-health-info-of-12-000-at-risk that describes yet another  fiasco pertaining to the loss of  health data.
Similar to the painter, I'm reading and asking: Did we not just paint these lines?
Remember the situation in Durham Region (http://durhamregion.com/article/177663) whereby local taxpayers are being held ransom to a potential $40 million lawsuit, again for lost health data?

Well, I suspect the mowing machines from the courts are gonna come calling with a class action to add yet another pile to our tab.
Did authorities not learn anything from the Durham Region loss? How many more similar lawsuits can we endure?
The part that really hits home for me was the following (my highlighting):

“Obviously, we are taking this very seriously,” Matthews told the Star’s Tanya Talaga, adding if the province had a far reaching system of electronic health records, this would not have happened.


“Health privacy is vitally important and when you think about the benefits of eHealth this is another one — when health records no longer have to be mailed...”

No kidding, Ms. Matthews! This tells me that perhaps one (or both) of the following is (are) true, at this time, for whatever reason(s):

• the Ministry is uninterested in shaking up eHealth
• the Ministry is powerless to do anything to improve the state of eHealth

Which do you think it is?
In any event, if you're part of the Ontario electorate, you'll have your chance to help make a change soon -- hope you'll jump at the opportunity!


Ernest A. James

President & CEO
Regal Informatics Inc.

e-Health -- it ain't easy!

I had the opportunity to attend  an "EMR" night in Ajax recently, hosted by OntarioMD (https://www.oma.org/Benefits/Pages/OntarioMD.aspx) for its members, and was really impressed by the turnout both from the health care provider (HCP) and vendor communities.

First up, as I toured the area assigned to vendors, I tried to imagine myself as a HCP and asked: which product would I pick?
Every vendor was touting the various benefits of their offering and I hardly have the time to do the due diligence that's really required!

Next came the presentations by OntarioMD representatives; Stephen McLaren M.D. was the first of three speakers, and I felt he vividly articulated many of the issues HCPs are facing, namely:

• whether they agree or otherwise, electronic patient data (its capture, delivery, manipulation etc.) is the future -- there's no escaping this fact
• some HCPs have refused to implement an EMR because of either reluctance or resistance; the former,  he stated, could be overcome by education -- regarding the latter, well let's just say he no longer partners with them in his clinic
• EMRs are challenging to implement -- for example, the vendor you decide on may not be around in 6 months; should this be the case, you could be plagued by compatibility issues as you try to move to a replacement product

I've enumerated the above to give a sense of some of the difficulties facing HCPs, and to highlight (and give reasons for) the fact that given the admirable efforts of OntarioMD and the like, EMR uptake (at least in Ontario), has been less than stellar (as of this writing, OntarioMD is touting 56% on its web site).
I still maintain that the current methodology used to implement EMRs (http://en.wikipedia.org/wiki/Electronic_medical_record) in Ontario is flawed in that:

• patient data should be co-owned by individual HCPs and the appropriate governing body for the region, e.g. Local Health Integration Networks (LHINs) in Ontario
• the HCP should access the data using a browser and their preferred vendor interface (i.e. xwave, Nightingale, OSCAR, etc.)
• LHINs should manage their own data according to their purview

From a patient perspective, I would need a full article to list all the benefits.
From a HCP perspective, issues such as security, business continuity, software updates and product compatibility would be eradicated overnight.
From the vendors' perspective, their businesses would be streamlined since they would only have have to deal with the LHINs as opposed to the numerous individual clinics.
From a LHIN perspective, what more efficient ways are there for both themselves and their constituents to be aware of what's happening in the community, health-wise?

So, everyone wins and as usual, the technology is already there -- perhaps budgets will eventually force the will!


Ernest A. James

President & CEO
Regal Informatics Inc.

e-Health -- security put to bed

The following two events have made me feel confident that security is no longer a roadblock to the effective implementation of Electronic Medical Records (EMRs) in Ontario.

Firstly, I received a notification from the Federal Government mandating the completion of a census survey within 10 days;  what caught my eye was the fact that the preferred method of completion was via a secure web site -- failing this, you'll have to make a telephone call to receive the paper questionnaire by mail (not recommended, considering the current postal disruptions).
It has become obvious to me that the Government has gone to great lengths to ensure we feel comfortable about sending our personal information over the Internet (see: http://census2011.gc.ca/ccr_r007-eng.htm) and is even threatening us with fines or jail time if we do not comply!
The point being made here is that if the authorities are satisfied with their process of data collection using the Internet, what makes using the latter for EMRs (http://en.wikipedia.org/wiki/Electronic_medical_record) any different?
This also begs the question as to why we're still unable to vote over the Internet, but that's another issue I'll tackle in another blog posting, in another life!

Secondly, I came across an article in my local paper (http://durhamregion.com/article/177663) regarding a $40 million lawsuit that Durham Region (Ontario, Canada) is facing, following the loss of a computer storage key during the flu vaccination season in 2009.
As a plaintiff, one could possibly feel some kind of satisfaction on hearing that the lawsuit is being allowed to proceed, but in reality, any restitution the courts find reasonable would be a Pyrrhic victory, since the costs will simply be passed on to its residents (i.e. the plaintiffs) by means of increased taxes or budget/project cuts.
One could perhaps argue that an EMR system could have done no worse, in that the requirement for Health Department personnel to carry externally stored data would be obviated.
Additionally, unauthorized access to systems hosting this data can more easily be detected via the "industry-standard" auditing capabilities of the various applications -- try doing that with paper records!

I now look forward to a similar Government-mandated electronic records implementation policy aimed at all health care providers.

Now, with regards to that aforementioned census survey, I'd better hurry and complete mine -- after all, this is not a good time for any "unplanned" vacation!


Ernest A. James

President & CEO
Regal Informatics Inc.

e-Health -- a question of perspectives

I was given a somewhat amusing insight into the different ways we perceive things at a recent meeting -- the following question was posed:
"How many people will be rising early on Friday April 29th, 2011 to see the William/Kate wedding?"
Most or all of the ladies in the room raised a hand -- after all, they just had to see Kate's dress; none of the men even moved a muscle.
A supplementary followed, perhaps in an effort to justify the ladies' decisions:
"Well how many people would be rising early anyway, if Kate arrived at the Abbey wearing just a Tee, cut-off jeans and sandals?"
All the men in the room raised a hand.
This was a moot point, however; irrespective of who did/didn't get up early, the wedding would still go on!

This got me thinking about elections -- I'd like to posit that although we all have our own perspectives about (or affinities to) the various political parties, the impact on Canada as a whole following the voting process will be negligible.
You see, today, Governments don't run countries -- finance markets do, and the latter are averse to any changes that may negatively impact the return of their investments.
Sure, each party may slice the pie differently, but the size basically remains the same irrespective of which party forms the new Government.

You've no doubt heard the leaders trying to upstage each other by offering to spend more on health care or some other line item in the budget, but one has to remember that the money has to come from somewhere and since the current economy does not easily lend itself to any substantial tax or debt increases, it's only logical that other programs will have to be curbed.

The following three examples shows who's in charge with stunning clarity:

• even on a Provincial level, we're being crippled by the deficit/debt; spending on health care, education and the interest on the debt eat upwards of 65% of the budget -- this is according to a recent Government of Ontario publication which amongst other things, details the various financial markets that service our borrowing needs and keep us in line
• Jefferey Simpson in a Globe and Mail article argues that the various leaders are making-up promises on the fly -- their platforms are wish-lists at best
• not only did the aforementioned financial markets send shock waves throughout the World economies, they forced the World's biggest economy to kowtow to them by forcing their Federal Reserve to hold the first ever news conference in its entire history

Notwithstanding the above, as a democratic nation, we're still obliged to cast our vote; I also think Ontario (and Canada as a whole) has a huge opportunity to help spend available health care funds more efficiently by doing the following:

• implementing nation-wide electronic resources (EMRs, EHRs) that share patient information
• using the above to allow individuals to monitor their own health via PHR systems

These are ways that could help us wrench back at least some control of our destiny.


Ernest A. James

President & CEO
Regal Informatics Inc.

e-Health -- an unwelcome "Welcome"

A newspaper headline stopped me dead in my tracks about a couple of weeks ago; blazed across the page were the words:

"Whitby hospital welcomes back patients".

The above caught my eye because for me, the words "hospital" and "welcome" give a sense of them being antonymous -- whenever I see/hear the word "welcome" I have a feeling of being happy to be in that particular location or place.

For example, on returning from a vacation abroad, there's a great sense of belonging on hearing the words "welcome back" from the immigration officer -- imagine hearing that at a hospital triage desk!

You'd probably never see me at an open house for a hospital -- that's a place one visits either to help cheer-up patients, or for emergencies -- I just feel uncomfortable being so close to that final resting place -- you know, the one with the "m" word to describe it!

With the utmost respect and understanding due, I realize there are those in our communities with chronic conditions that welcome the availability of additional resources to help them cope, but notwithstanding the latter, I think the above-noted headline suggests it may be time we change the way we think about health care facilities; for example, perhaps we should:

• remove all those signs that seem to be proliferating in our various communities -- emergency personnel are already only too familiar with the location of the appropriate facilities
• replace them with those that direct us to recreation centers

Wouldn't it be wonderful if, while travelling Ontario highways, one would see "10 km to next rec center" as opposed to "Hospital next exit"!

This could help foster a society that places personal health as the top priority using tools such as exercise, EMRs, EHRs and PHRs to maintain their health.

As a friend of mine remarked:

 ..."you never hear someone with an age range of an octogenarian or higher, crediting their local hospital or physician for their longevity -- it's always because of their lifestyle!"

Since we're in election season, I'm wondering if it's time to start thinking of the formation of a Provincial party that has physical fitness as its main platform; I can just imagine one version of the agenda being:

• a substantial reduction in health care expenditures
• a laser-beam focus on electronically linking all our provincial health care facilities
• allowing secure Internet access to patient data
• tax relief for personal physical fitness expenditures 
• an increase in the education budget (particularly that portion pertaining to personal health)

Would you vote for such a party? I'd love to hear from you!

Ernest A. James

President & CEO

Regal Informatics Inc.

e-Health -- a tale of two cities

Following the tremendous amount of rainfall we experienced over the weekend, I was really hoping it would obliterate any/all evidence of winter, but alas, it appears "Ol' man Winter" is still up for a fight!

Speaking of dashed hopes, I was also looking forward to much more fallout from the news story we heard a couple of weeks ago whereby hospitals were threatening elderly patients with fees way over and above the limit prescribed by the Ministry of Health; I found the practice to be usurious, despicable and morally reprehensible, perhaps because it struck a chord with me -- you see my mother is also a senior and to quote John Bradford: "...but for the grace of God...".
I'm being especially critical here because, disregarding the higher rates being charged for a moment, this policy also wreaks emotional havoc on the elderly and their families -- just imagine being told that your mother/father has to be placed in a nursing home in unfamiliar territory, tens of miles from home, just because of a bed shortage!
Friends of mine who work in healthcare had mentioned this, but I always felt it to be a distant possibility, as opposed to being actual hospital policy.
Note this was happening at one of our bigger Toronto hospitals that has as its mission statement: "We care for our patients and their families when it matters most" -- my imagination went wild as to how widespread the practice was amongst the smaller ones in the GTA!
To my surprise and dismay, the only fallout from the above was that the Ministry of Health (MOHLTC) simply sent a reminder to the LHINs of what the daily charges should be, and that was the end of that -- or so I thought!

Shortly after, I saw another story whereby McGill (Montreal, Quebec) was slammed with an undisclosed fine by the Quebec Government for raising their tuition fees by 900%; now, based on my understanding of Maslow's hierarchy of needs, education (Self-actualization) has a much lower priority than healthcare (Safety), so one could perhaps assume the offending hospitals would, at a minimum, be also levied a heavy fine for raising their rates by upwards of 3,000%!
I later resolved that anomaly in my mind by thinking perhaps the MOHLTC realizes our hospitals couldn't afford any fines anyway, so the latter would just be an exercise in futility.

So, what would be my take-away on the above? Well, I would start with the following:

1. to realize our hospitals are cash-flow challenged and that they're prepared to push the envelope to mitigate the latter
2. to partake of a small glass daily, based on a recent University of Calgary study
3. to resolve to get acquainted with and use EMR, EHR and PHR technologies, wherever possible

The above steps should hopefully go a long way to both increase awareness about healthcare in Ontario and perhaps minimize any need for it.

Ernest A. James


President & CEO
Regal Informatics Inc.

e-Health -- grooming the horses

Like many people, I watched the Super Bowl on February 6th, 2011, and came away awestruck at the capabilities products/people were purported to be imbued with; for example, you probably saw the child with Darth Vader-like powers starting a car engine, or a Chevy truck promising to extract victims from the bowels of whales.
I was jerked back into reality the next day when I heard something that gave me cause to pause -- one of my favorite radio stations, after asking us to guess how many actual minutes of play there was in the 4-hour behemoth, finally told us the answer -- 11 minutes!

Which brings me to the upcoming Provincial horse race (aka, election) -- I'm wondering how many minutes of real play we'll get out of this one!
In fact, the rhetoric has already begun -- there's an article in my local paper that reported on a recent speech by Tim Hudak to the Clarington Board of Trade;  he's quoted as saying how he'll eliminate the LHIN system, take the $250 million and plank it down in front of  our hospital administrators to bait them into improving front line health care.
Hhhhmmm; to me, that could be easier said than done -- even if Mr. Hudak becomes Premier and he's true to his word, it'll take the Conservatives years to unravel such a setup, and at what cost?
Wouldn't it be much more efficient to accept reality and to improve rather than tear down?
For example, how about a mandate for compatible EMR and EHR systems at all health care provider locations in the Province, by 2014!

Of course the Liberals aren't too shy either -- quotes coming from their pre-election get-together in the nation's capital almost have me waxing poetic:

People of Ontario, have no fear
There will be more money for health care

Personally, I can't wait to see where they're gonna get more fuel to dump on a $46 billion fire (aka our health budget)

Stay tuned for the Super Bowl-type ads, for like Spring, they're a-coming!


Ernest A. James


President & CEO
Regal Informatics Inc.