e-Health -- may your health shine brightly

Living room in Durham, ON

I was visiting with Chris and his family last week and admiring the Christmas tree that was adorning the living room of their home; I thought to myself: wow, it doesn't get much bigger/better than this!

Well, I was wrong, again! A couple of days later, I was visiting with Katie and her family and was struck by how much bigger their tree was; I soon clued in to the fact that in Katie's house, the ceiling was much, oh, much higher, so a bigger tree could easily be accommodated.

Believe it or not, this helped me relate to the recent news about the deal between the OMA and the MOHLTC; the parties were at loggerheads (heck, the OMA even took the MOHLTC to court), but they somehow managed to hammer out a deal the OMA thought would be acceptable to its members.

The way I see it is that the OMA tried to get more "whatever" on the table, but the Government balked because increasing the debt or raising taxes are not options readily available to them in today's environment -- in other words, they were limited to the space available on Chris' tree -- Katie's bigger tree was out of the question.
So, to get the OMA's trinkets hung on Chris' tree meant ditching/altering some already present.
One of the trinkets affected, in healthcare parlance, is the annual physical exam -- we're being told they're being "scaled back" to fit requirements on a personal basis.
 I'll leave the interpretation of that to you, but my guess is that some of your trinkets on last year's tree have either disappeared or been significantly modified.

You gotta give it to the OMA -- they've done a magnificent job representing their members, but this raises a question, namely: who's got your back?
Of course, at the end of the day, the answer is: you and only you!

Remember, the only way to properly manage your health is to:

•  have your health data at your fingertips (think EMRs, PHRs etc.) 
• work with your healthcare providers to properly interpret that data
• ensure you eat/sleep well, and exercise regularly -- especially during this time of year
• maintain great relationships

So next time the MOHLTC comes-a-calling for more of your trinkets, you'll be well prepared.

Have a safe and joyous holiday season!

Ernest A. James

President and CEO

Regal Informatics Inc.

e-Health -- let my people go!

For me, nothing drives home the message that cooler weather's on the way better than the various pumpkin displays at the local stores, or streets lined with yard waste collection bags.
Nature's about to begin it's annual rejuvenation thing and as you know, this is no easy process, by any means.
Various life forms intuitively cope by eating an inordinate amount of food, then hibernating in Winter to save energy.
The whole thing then culminates with a burst of energy and revitalization in Spring.

The above kinda dovetails nicely with an idea that's been floating around in my head regarding the path eHealth Ontario (eHO) should follow -- let me set the scene:

• I recently attended a CHWP information session regarding their version of a PHR, amongst other things
• I also read regular updates on the cGTA project (see page 20 of the CELHIN document)
• eHO is apparently in the same line of development work

All of the above pertain to implementation plans for a long-time wish of mine, namely, connecting healthcare providers to facilitate the free-flow of patient information, and also allowing us to view our own records on-line.

My understanding of the CHWP and cGTA projects is that they're being run (at least from an application standpoint) by private companies.
What I would really like to see is the proverbial 3-horse race, i.e., one that includes eHO, free of Provincial Government encumbrances.

I know of a number of highly skilled employees who would just love to strut their stuff without one hand being tied.

So in that regard, my recommendation for the Provincial powers that be is this: cut 'em loose!
Let eHO use its extensive knowledge/expertise of/in the industry to compete privately with CHWP and cGTA to build the best backbone infrastructure possible for a Province-wide EMR system.
Sure, there may be some falling of leaves followed by dark days of winter-like conditions within the organization, but Spring will come and I can almost guarantee it'll be a net win for all involved and ultimately for our healthcare system.

I hope you've begun your routine to keep healthy over the coming months -- the weather pundits are predicting a tough winter; now, where did I toss that travel brochure...


Ernest A. James

President and CEO
Regal Informatics Inc.

e-Health -- they're back!

A bridge somewhere in Whitby, Ontario

I love walking around my neighborhood since it seems to help clearing my head.
Things were going great one morning -- until I heard/spotted the construction crews.
Strolling by, I realize they're digging up concrete on a newly-refurbished bridge that's barely had time to cure.
My curiosity gets the better of me, and after asking a few questions and learning this was not related to any emergency, yet another question pops into my head, namely:
why can't utility service providers and infrastructure maintenance personnel get together for some long-term planning?
Why do they have to line-up in anticipation of ripping and replacing each other's efforts?

If you're expecting a segue by now, you'd be bang on because this is exactly what's happening in the world of Electronic Medical Records (EMRs); you see health providers are busy creating islands of information that are not interconnected; when the software bridging functionality becomes available (and it will, driven either by consumer demand or budgetary restrictions), these newly installed software systems will have to be replaced by versions that speak the interoperability language -- at a huge cost to us all.

So, who do I think is to blame for this? Who do I think can fix this?
Well, it's hardly the software providers' fault since it's in their interest to get their products out the door in a timely manner -- their business models do not allow them to wait around for the industry to agree on compatibility.
As I've been advocating, this has to be in the purview of the LHINs -- they have the option of setting compatibility standards for their areas of responsibility, forcing software providers to comply if they wish to continue doing business with their various health providers.
If the LHINs get this right, other Provinces will follow and soon Canada could be a world leader in terms of EMR standards.

However, until someone sees the light, we'll just have to get accustomed to the noise of jackhammers continually tearing up the concrete in our health care infrastructure, I guess!

Hope you're continuing to enjoy the Fall weather -- just remember where you left the rake prior to answering that all important phone call!


Ernest A. James

President & CEO
Regal Informatics Inc.

e-Health -- get out of the way!

Great Wall, China ©
Used with permission

For various reasons, China's been on my mind over the past couple of weeks; for example, I was wondering about the logistics involved in implementing an Electronic Health Record (EHR) system to a population of upwards of 1.3 billion people.
My vote would be for one that's:

• built by private enterprise 
• decentralized in nature, since the odds against a successful centralized (Government controlled) system would be almost incalculable, to my mind!

This lines up well a recent speech given by Industry Minister Christian Paradis to the Economic Club of Toronto in which it was reported he commented on the fact that he'd like to see Government getting out of the way to enable Canada to become one of the leaders of the digital economy.
Hopefully this extends to e-Health because I've always held that the latter should be similar to our highway systems, namely:

• Government builds, maintains and polices the infrastructure
• private industry builds the systems that use the above
• any other way is most likely doomed

Translated to an e-Health scenario, this would entail the Government of Canada building a Canada-wide digital infrastructure that allows the various Provincial health systems to communicate securely and reliably -- and in the case of Ontario, the various LHINs building out their various health provider information systems in partnership with private industry.

One tends to think that Government-mandated projects seem to dovetail nicely with the lifespan of the party in power, but I'm hoping the current e-Health project in Ontario not only transcends this, but is simply concerned with matters of infrastructure.

Sadly however, the author of the above-noted article, Michael Geist, feels that this will end up as just another speech; only time will tell.

Here's to your continued good health and a picturesque Fall season.


Ernest A. James

President & CEO
Regal Informatics Inc.

e-Health -- time for a little vinegar?

Kingston, Ontario

Although the Olympics has ended, I still feel the urge to tune in for a late night review of the day's events; I'm also looking forward to the next major sporting events in 2014 and 2016.
Funnily enough, these same schedules remind me of the implementation of Electronic Medical Record systems (EMRs) right here in Ontario; since getting involved with this particular industry sector in 2008, the deadline just keeps getting extended.
For example, the OntarioMD website is now advising that the EMR Adoption Program has been extended until 2014.

This state of affairs has not gone unnoticed, even amongst doctors themselves; for example, a very interesting Healthcare Papers article entitled: "Of Honey and Health Policy: The Limits of Sweet, Sticky Substances in Reforming Primary Care" has the author (Danielle Martin MD, CCFP) asking the question: Is honey enough?
In the above-mentioned article, Ms Martin discusses how incentives have been used to move healthcare providers from individual care to more team-based/better coverage systems.
However, she posits that honey alone will lead to slow and incremental change for healthcare in Canada.
The clincher for me comes when she comments that one of the policy tools Government has -- authority, is missing from primary care in Canada.
She goes on to state that:
"Governments have some ability to legislate and regulate some of the conditions necessary for true primary care renewal... So far they have treaded lightly in the area of primary care other than to invest heavily in incentives; but more could be done."

I've long been an advocate of such policy initiatives as the EHR stimulus being implemented by our friends to the south; basically beginning in 2011, a healthcare provider can claim funding -- should you not have a functioning Electronic Health Record (EHR) system in place by 2015, any reimbursement claims you submit to the Government will be penalized on an annually increasing scale.
This is perhaps the type of action I sense Ms. Martin is calling for; coming from an insider, I find this particularly refreshing.

Until next time, stay healthy!


Ernest A. James

President & CEO
Regal Informatics Inc.

e-Health -- could this really happen?

Canada's Wonderland

I recently came across an E-mail message entitled "...coming to Ontario in 2013" which basically detailed a "futuristic" type of a conversation in which one Dr. Suzanne Allen describes the curtailing of medical procedures such as dialysis, stent insertion, kidney transplant and the like.
Apparently as early as 2013, no one over the age of 75 would be allowed a Ministry of Health (MoH)-approved major medical procedure, unless sanctioned by a local ethics panel.
The above-mentioned message ends with the following plea:
"This is a graphic reminder of the need to stay healthy. Get your [burial] plot now at your earliest convenience..while they last."


I quickly donned my sceptics hat and scurried over to the Snopes website to assess the veracity of the message, and was relieved to see that it was just another fake, as outlined in the response.

However, this was not the end of the matter, for I began to wonder what would happen should there be even a modicum of truth in what I had just read!
Suppose for example, that you awoke one day to the news that medical procedures were being rationed in Ontario because of budget constraints?
Your reaction may be one of ridicule, but is this an impossibility? Really?
Though I'd rather not be branded as a scaremonger, I still feel we need to be cognizant of the following:

•  black swan events such as 9/11, or the north-east power outage in 2003 are in the history books; they were, true to form, totally unexpected
• a friend informed me that her doctor has indicated boundary restrictions within Ontario are already in effect, i.e. new patients must seek healthcare services in the municipality where they live
• the OMA is currently at loggerheads with the MoH; one paragraph in a newspaper article aptly describes the gravity of the situation by stating: '[OMA president Dr. Doug] Weir would not put a price tag on the legal action being handled by law firm Heenan Blaikie LLP but said: “We are certainly prepared to pay whatever it’s going to cost.”'

So, now that our awareness levels have been ratcheted-up at least a notch, what can we do to mitigate should anything similar to the above occur?

Well, the following ideas immediately come to mind:

• maintain your efforts to remind your doctor why she needs an EMR (should such a system not currently exist in the clinic) -- all the ammo you need can be found here
• be prepared to switch to a healthcare provider that uses an EMR -- it's really that important to the management of your health
• you need information for the above -- unstructured data (i.e. paper records) cannot be easily turned into information
• better still, begin adopting the mindset that you should really be the custodian of  your (and perhaps your family's) health information (aka PHRs) -- stay tuned -- tools are coming to help you manage this

So until next time, enjoy the weather; and please, watch out for those lightening bolts!

Ernest A. James

President & CEO

Regal Informatics Inc.

e-Health -- how to live

Scarborough, Ontario

To the untrained eye, all indicators seem to be pointing to a red-hot Summer; my reaction? Bring it!
Talking about temperature, I must admit that mine increased somewhat after I came across the June 11, 2012 Time magazine edition with the words: HOW TO DIE emblazoned across the cover page.
However, as you know, things are not always what they appear to be; you see, the author (Joe Klein) simply wrote about his experiences dealing with the declining health of his parents in a nursing home that's part of the Geisinger healthcare system (remember that name 'cos it's coming to a LHIN or similar healthcare administration system near you).

The author's argument is that "fee-for-service" is destroying our healthcare systems; he continues by positing that doctors naturally gravitate towards ordering that extra test either because they can, or to mitigate the chances of a malpractice lawsuit.
However, a healthcare system can only do so much before it becomes financially unstable; where's the value in costly surgical procedures or lab tests if they do not measurably increase quality of life? This becomes especially relevant when end-of-life issues are involved.

The site Cost of care quotes from a speech given by Peter Orszag, Director of the White House Office of Management & Budget in February 19th, 2009, one that's not only pertinent to the situation in the U.S., but also in other countries.
He states:
"We seem to have as much as $700 billion a year in health care tests and services that are unnecessary, that don't improve health outcomes, and that just add to costs both for the federal government and for workers without making anyone healthier. The way to get at that has been started in the stimulus bill in which we invest [$20 billion] in health information technology, we start to better measure what works and what doesn't, and we start to pay for better care rather than more care."


The need for different types of healthcare systems such as Geisinger's is what's being alluded to by the above, perhaps with the following attributes:

• they make full use of Electronic Medical Records (EMRs)
• healthcare providers are employees of the systems
• they help families make educated decisions about difficult treatment options for patients

There's no doubt that an emotional ingredient is also in the mix when it comes to healthcare -- who can argue with someone's efforts to try to prolong the life of a loved one?
In that vein, this article makes no claim as to the suitability of any system; what I'm hoping for is to help jam a steel-capped boot into the crack of the doorway of discussion that's been opened by this article -- may it never be closed again!
Perhaps that article should be entitled "HOW TO LIVE", since  caregivers are normally the ones who have to make and live with these decisions.


If you haven't read the magazine article, I suggest you place it and this video on your reading/viewing list; you may not need to read/see it today, but tomorrow, who knows?


Until next time my friends, I wish you good health -- watch out for those barbecue flare-ups!



Ernest A. James


President & CEO
Regal Informatics Inc.

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.