The state of eHealth in Ontario

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

2012-02-14T10:00:00.000-08:00

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

2012-01-05T10:16:00.001-08:00

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

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

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

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

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

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

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

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

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

To your continued good health!

Ernest A. James

President & CEO
Regal Informatics Inc.

e-Health -- part III, a disruptive idea

2011-12-05T13:39:00.001-08:00

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:

patient quality of life
number of drug prescriptions
diagnostic tests
use of technology
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

2011-11-24T12:14:00.001-08:00

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

2011-10-13T15:16:00.000-07:00

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

2011-09-11T19:58:00.000-07:00

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?

2011-08-09T12:38:00.000-07:00

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!

2011-07-11T14:24:00.000-07:00

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

2011-06-06T10:54:00.000-07:00

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

2011-05-11T06:20:00.000-07:00

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"

2011-04-11T12:28:00.000-07:00

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

2011-03-08T20:25:00.000-08:00

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:

to realize our hospitals are cash-flow challenged and that they're prepared to push the envelope to mitigate the latter
to partake of a small glass daily, based on a recent University of Calgary study
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

2011-02-09T16:05:00.000-08:00

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.

e-Health -- new year imponderables

2010-12-30T09:57:00.000-08:00

I had occasion to visit my local walk-in-clinic over the holidays and as usual, took the opportunity to observe what was going on around me; it was 08:00 on a Sunday and the waiting room was packed within 5 minutes of the doors being opened.
As I sat there, a slew of questions began forming in my mind, such as:

why do doctors' offices close -- do we really think illnesses follow the concept of a "work-day/week" and observe statutory holidays?
why do we still refer to the "family doctor", as if the latter is obligated to stay around to serve us until we depart planet Earth?
why does the Ministry of Health (MOHLTC) seek so desperately to reduce hospital emergency room wait times, yet apparently has no coordinated plans to ensure 24/7 primary healthcare provider (HCP) coverage?
why is the MOHLTC gung-ho on the EMR, yet we hardly hear any discussion on electronically linking healthcare facilities so patient data can easily be shared?

Of course, I not only thought about the questions/issues -- heck, I tried to solve them all by myself!

For example, I'm thinking that:

using the FHT concept, primary HCP clinics should be staffed 24/7 and managed by the LHIN for any given area
a hospital's emergency department should be for life-threatening situations only -- if you can get there under your own steam, you should really be visiting a primary HCP clinic
we need to stop this nonsense about ownership of patients' records -- the latter should be electronically stored and managed by the LHIN with access allowed as appropriate (patients included); do we hyperventilate about ownership of our tax/banking/insurance records? Patients' records should simply be one of the tools used by HCPs/the MOHLTC to help provide best-of-breed care for Ontario residents

The more time we spend debating this, the closer we'll get to privatization (yes, I finally said the "p" word) -- there's no way our taxes can sustain the level of spending our healthcare system requires, for any appreciable length of time -- something's gotta give!

I'm hoping an election year will help spur on some badly-needed changes.

Wishing you the best for 2011.

Ernest A. James

President & CEO
Regal Informatics Inc.

e-Health -- a moment of clarity

2010-12-12T19:43:00.000-08:00

I had the opportunity to attend the October session of the CE LHIN board meetings and I must confess to leaving the latter with a quizzical look and my mind running in overdrive; the Project Management Office gave an excellent overview of what the "rubber hitting the road" was like for them -- the latter was actually an inspiration for the previous post, in that I feel we need to hear more of the experiences of the folks on the front lines.

During the afore-mentioned presentation, I thought I heard something to the effect that efforts at implementing the various e-Health initiatives (such as a data center consolidation amongst the LHINs) were being stymied by the various hospitals bringing along their lawyers to the meetings.
On the way home, I began beating up on myself for not listening more attentively, for I determined there was no way LHINs could be shooting themselves in the foot by funding lawyers to, at best, slow down the progress being made with their projects, or so I thought...

Fast forward to November 30th, 2010 -- I was vegetating in front of the TV after a hectic day; flicking through the channels during commercials, I came across a TVO episode entitled "Patient-Centered care".
I quickly got back into listening mode and was taken aback at what I was hearing; stuff like "turf wars" amongst Healthcare Providers (HCPs) was vigorously being debated.
Elinor Caplan, a former Minister of Health for Ontario described one of her experiences that really had me shaking my head -- basically, she had met with two hospital boards that were planning the implementation of e-Health systems and pleaded with them to at least ensure compatibility was included in their specifications.
What did the hospitals do? They ignored her request, shored up their turf and ended up with systems that couldn't "talk" to each other, in effect creating more islands of information.

I have always contended that the state of e-Health in Ontario was not due to any lack of technology or security (systems that allow us online access to our income taxes or banking information are solid testaments), so the above discussions really put things into perspective for me.

So, what will it take to get some movement away from this "my patient data" way of thinking? Well, one way or another, it's got to happen.
Now, I'm not optimistic that HCPs will become altruistic and voluntarily begin sharing their data overnight, so I suspect we'll see something mandated by early 2012, at the latest.
I think we've had enough discussion -- it's now time for action -- the current state of affairs is unsustainable.

I wish you a safe and joyous holiday season and look forward to one interesting year ahead.

Ernest A. James

President & CEO
Regal Informatics Inc.

e-Health -- where is John Q. Public?

2010-11-10T14:49:00.000-08:00

I normally look forward to attending the monthly Board of Directors' meeting for the Central East LHIN, but I always wonder why there's such a small (if any) representation from the rest of the community.
I've checked with friends from other LHINs and none of them has ever attended a meeting, so let's assume for the purpose of this discussion that my research is empirical.

There were only a couple occasions that I can recall where extra seating capacity (or a different venue) was necessary, and these were:

the session discussing the realignment of COPD services in the Durham, Ontario region -- many of those living with the disease were out in full force to show their concern for aspects of the LHIN's plans
the session regarding the reorganization of the PHRC

So, why the apparent disinterest?
As per the MOHLTC, "The legislation requires LHINs to engage their community, including physicians and other health care practitioners, on an ongoing basis..."
Now, I presume the mandate is being measured, so on this "engaged community" metric alone, the LHINs must be hurting real bad!

What could they do to counter this apparent indifference? I have a couple of ideas.

Firstly, why not market the LHINs to the point of ad nauseam?
Many Ontario residents I interact with have a fundamental lack of knowledge of what LHINs are all about -- I find this unfortunate since the latter funds their healthcare.
It's said that even tourists to Canada know the Pizza Pizza phone number, so why are we so conservative when preaching the LHIN gospel?

Secondly, I feel the level of interest would be raised considerably if someone from the front-line of our healthcare system would be asked to present at every board meeting.
For example, I may be interested in attending if it became common knowledge that the manager of the Emergency Department (ED) of my local hospital would be discussing:

the serious effects on "wait times" of me showing up just because I have a cold
other options available to me, such as Telehealth Ontario

My doctor would definitely have my attention if she informed me that she'll be presenting as to:

why she and her peers are still not accepting new patients
why she's recommending to all her patients that they assume a greater responsibility for their health
how tools such as EMRs, EHRs and PHRs would help with the above

I think the optics for the LHINs would be greatly improved if they tried to connect with their communities more often at the grassroots level -- I've attended too many meetings where I've had to turn and ask the meaning of acronyms being thrown around by presenters.

Let's turn these board meetings into true "town hall" meetings -- that way there'd be no need to question the value of our LHINs.

Ernest A. James

President & CEO
Regal Informatics Inc.

e-Health -- should the user pay? Part 3

2010-10-05T10:21:00.000-07:00

I was of the impression that this pay-per-use discussion was a done deal, but it appears to be otherwise; you see, the Quebec Minister of Finance, Raymond Bachand has made a decision not to go ahead with the implementation -- negative feedback from the public at large was just too overwhelming.

However, he has also elected not to ignore the elephant in the room -- folks in Quebec will still be hit with a charge to their income-tax accounts of $100 beginning next year and escalating annually; after all, similarly to what we're experiencing here in Ontario, the health care budget issue will still have to be dealt with and giving in to public opinion doesn't simply make it disappear.

Speaking of health care budgets, it's interesting to note the pre-election rhetoric both from a Federal and Provincial level; for example, the leader of the Federal Liberal party (Michael Ignatieff) has promised an up-coming debate on health care in his recent Nova Scotia caucus address; he's also hinting at the types of changes his party would make if elected -- for example, prevention ("more health, less health care") would be a top priority; also, as indicated in an earlier post, user-pay would not be an option.

Provincially, Tim Hudak has promised to disband the LHIN system in Ontario if his party gets elected next year, using the money allocated to its administration for more front-line care.

Although we're not privy to the details, it's obvious to me that we're on the cusp of a revolutionary change in the way health care is administered throughout Canada -- I think we can all agree that the current way of doing business is unsustainable; elections in 2011 will probably be watershed events.

So, how do we mitigate the soon-coming upheavals? My suggestion is, as always, the use of technology; EMRs, EHRs and PHRs are tools that will both help us to take control of our health and ease the demand on our health care systems.

I think the need for change is superbly articulated by a comment I came across recently -- it states: "There's never enough money to pay for disease".

Ernest A. James

President/CEO

Regal Informatics Inc.

e-Health -- should the user pay? Part 2

2010-09-14T11:52:00.000-07:00

So, I'm heading home after the meet/greet luncheon with Michael Ignatieff, feeling chuffed -- just had some good food, took a picture with a potential Prime Minister and got a definitive answer for my question.
However, I habitually try to play the so-called "devil's advocate" role and found myself asking, is it really a big deal if user fees became a reality in Ontario? And when it does, can there be any reasonably pleasant side effects?

After some searching, I realize this could potentially be the needed wake-up call for many of us; people like myself tend to abuse anything we do not have to pay for, at the time/point of usage -- OK, I admit, if I'm staying in a hotel, I may leave the tap running as I polish the ivories, but as you can imagine, my habits would change when I got home!
In other words, if I know I have to pay, I'll try my best to be frugal -- if it doesn't cost me anything immediately...

So being a realist, my suggestion to the Health Minister of Ontario would be to at least give those who make the effort to turn off the tap, a tax break; for example, if an across-the-board $1,000 user fee was levied annually on working Ontario residents, and I also paid a $1,000 annual membership fee at my local health/fitness club (something that I used snow, rain or shine), at least make it revenue neutral to my tax account with an equivalent credit at year end -- something similar has been implemented for the use of public transportation, so why not healthcare?

I'd regard it as unconscionable if I made the effort to stay healthy whilst my neighbor simply slaps the alarm clock across the room at 06:00 hours and turns the other cheeks, so to speak! Yet, we'll pay the same user fees at year's end.

I'd also be doing a disservice if I were to be reticent with regards to the various options available before we got to the point of user fees; I was really disturbed by an article sent to me by a friend -- here are some of the eye-popping revelations I read:

the most dangerous place in Canada is a public hospital
one in every 152 acute care patients dies because of "preventable adverse events"
two in 10 patients contract a hospital-spread infection or are given the wrong medicine
no Canadian CEO could keep his job if his company’s "defect rate" was even a small percentage of that in our government monopoly health-care system

I passionately feel that:

the inefficiencies should be removed from the system before user pay is even considered
people should be given access to tools such as EMRs, EHRs and PHRs, along with constant reinforcement messages/education sessions to help them maintain their health.

Only when the above efforts have been exhausted should the Health Ministry think about implementing user fees, along with the associated tax breaks to both reward and encourage us, of course!

As with any system, regular maintenance tends to prevent breakdown and the abuse of repair facilities.

e-Health -- should the user pay? Part 1...

2010-08-10T12:17:00.000-07:00

I was thumbing through my weekly pile of reading material when the words "$25 fee per doctor visit" caught my eye -- apparently the Quebec Government wants to implement a user pay-per-visit healthcare system.
The above-noted article goes on to inform us that a "health contribution" will also be levied; to me, what's really interesting about the latter is the way it's being implemented -- apparently, you won't be dipping into your purse/wallet for this one -- oh no, for your convenience it's being shoe-horned nicely on to your income tax bill -- now, who could be upset at a government for being so understanding?
For this "health contribution", the plan is to charge Quebecers $50 in 2010, but since the budget was passed during the year, they get a 50% discount; for 2011, they'll reach for $100 and this doubles in 2012; sorry, but there are no prizes for guessing where it's heading after 2012!
This tax grab will further lighten the residents of Quebec's pockets by close to a billion dollars annually.

I love the following paragraph on page 22 of the 61-page report (my emphasis):

"The health contribution is a simple and effective way to provide substantial funding for the health-care institutions, but without demanding an excessive effort on the part of each taxpayer."

What this really means to me is that they need a quick and easy way to get more funding for healthcare; forget the effort required to find other means (e.g EMRs/EHRs /PHRs) of squeezing inefficiencies from the system -- heck, they should have this thing up and running in no time at all.

After I finally managed to get the remnants of my receding hair-line back in place, I filed the article and continued reading; curiously enough, another article soon catches my attention -- this one informed me of an upcoming visit by the leader of the Federal Liberal Party, Michael Ignatieff -- he would be the guest at a luncheon hosted by the Ajax/Pickering Board of Trade; ah, the wisdom of the Universe, I thought -- dropped right there in my lap was an opportunity to put a question to the man himself -- to get the official word on how the Liberal Party would deal with such a potential contravention to the Canada Health Act.
After all, one could be forgiven in thinking: this is Ontario, it'll never happen here; well, just remember that the Premiers meet on a regular basis and there's no reason to believe the "honey-pot syndrome" does not apply when they do get together!

So, on the day in question, I donned one of my best blazers, made my way to the convention center, and waited; soon the crowd became agitated as word of Mr. Ignatieff's arrival spread amongst the tables.
In he walks and my jaw drops -- he was dressed in the exact same style/color of blazer -- my immediate concern was: how would the luncheon crowd be able to differentiate between the two of us? Then it hit me -- it would be easy -- I was the handsome one, silly!
I relaxed, enjoyed the lunch and prepared to queue up behind the microphone, but alas the time for questions ran out, so I decided to wait outside the room and try to get his attention as he was leaving.

Let's continue this in part 2 where I'll discuss how I ruminated on the answer I received from Mr. Ignatieff; in the meantime, there's something that's demanding my immediate attention -- as I'm writing this article, the air is muggy and the sweat's pouring from my forehead, yet there's a story on the radio about stores in Toronto displaying winter coats; this is madness!

Photo credit: Dave Stell

Ernest A. James

President/CEO
Regal Informatics Inc.

e-Health -- PHRs in the spotlight

2010-07-12T18:03:00.000-07:00

Sounds of silence reverberated around the soccer world on the afternoon of Friday July 2nd, 2010; Brazil had just been eliminated from the FIFA World Cup of Soccer in South Africa after being beaten by the Netherlands, a team many thought didn't stand much of a chance to advance.
From the perspective of Personal Health Records (PHRs), I'd say something similar (relatively speaking) occurred in Canada when Telus announced its entrance onto the e-health stage at the end of May, 2010.

A couple of weeks later (and unaware of the announcement), I attended a conference in Toronto where Telus management gave a keynote speech informing attendees of the company's portfolio of Information Technology (IT) products and services; from data center management to consulting, Telus is much more than the phone company I had envisioned it to be -- the media release therefore made a lot of sense when I did manage to read it.

This is huge; you see, Microsoft and Google already have PHR products, but one of the main concerns I regularly hear discussed is the fact that since their data centers are mainly located in the USA, customers' health data could be subjected to the vagaries of the Patriot Act -- people are basically concerned that their medical history could be searched, copied, destroyed or generally made unavailable should the government feel such actions to be in the best interest of the country.

Well, the Telus announcement has in effect eradicated all of those concerns; here we have one of the top 500 companies in Canada (heck, it's right up there with Rogers Communications Inc. and BCE Inc.) teaming up with Microsoft, one of the top ten software companies in the world to bring us an e-Health application that's geared to Canadians; based on the history of the players involved, it'll be secure, reliable and easy to use.

As a refresher, a PHR application will allow you to capture, upload, store, display and manage health-related information that's owned by you -- just imagine the following possibilities:

you move to a new city and there's no need to purchase a CD/DVD of your history from your previous healthcare provider beforehand -- everything you need is as close as the nearest web browser
you get home from a vigorous workout and you just have to plug the device that was strapped to your arm into your computer device to upload data that can include heart rate, blood pressure and distance traveled
you need to record your blood pressure or other attributes daily -- don't worry, devices are coming that'll store the data and allow you to upload to your PHR at your convenience
soon you'll be able to show off your superb physical condition to interested parties using your iPad/iPhone or similar device, because there'll be an app for that too

I predict that we're on the verge of an explosion of activity in the area of self-help health management; stay tuned -- my pledge is to keep you apprised.

Well, the games have ended; the team I was following just managed a place on the podium, but I predict vengeance will be exacted in Brazil in 2014.

In the meantime, I'm immediately putting in place a savings plan to ensure I can afford the Brazilian version of the vuvuzela.

Image credit: Salvatore Vuono

Ernest A. James

President/CEO
Regal Informatics Inc.

e-Health -- EHRs to the fore

2010-06-12T06:00:00.000-07:00

I had volunteered to help out with a Rouge Valley Health System Foundation (RVHSF) fundraising activity -- we were tasked with selling raffle tickets at a Pickering Rotary event, to support the pending acquisition of a Magnetic Resonance Imaging (MRI) machine for the Ajax/Pickering hospital.

On the way to the park, it struck me that I knew nothing about MRI machines and should anyone ask me to explain the latter, it would be interesting to hear my response.
I resolved that Durham Region folks are a knowledgeable bunch and this would be a non-issue.

True to form, not one of the many people I met that day needed to know what an MRI machine was -- they either pleasantly declined or were happy to contribute and my allocation of tickets went quickly; I guess the combination of good weather, good looks, a great cause and pricing came together in a perfect storm, so to speak!

This got me to thinking about the day when Electronic Health Records (EHRs) and Electronic Medical Records (EMRs) finally become as pervasive as MRI machines -- I have no doubt it'll be soon! The next couple of paragraphs give me cause for such optimism.

I attended the Central East Local Health Integration Network Symposium last month and was pleasantly surprised at the emphasis the president of the Ontario Medical Association (OMA), Mark MacLeod (M.D.) placed on EMRs/EHRs; to paraphrase, he told us that EMRs is the grease needed to move patients through the system more efficiently; he went on to say that more work needs to be done to connect family doctors to hospitals.
Wow, I think for the top guy from the OMA to include such a topic in a major speech is very encouraging!

I also recently tuned into a webcast from the Institute for Functional Medicine's 17th International Symposium -- the topic was: "Looking Anew at Cancer"; I thought I'd be hearing some earth-shattering truths from the speaker, Jeffrey Bland (PhD, FACN, CNS), about how to easily prevent cancer.
However, I was soon overwhelmed by the complexity of the ideas presented, until he made a statement that made me sit up and listen even more intently -- in effect, he indicated that pattern recognition was a critical tool in cancer treatment and one of the best ways to collect, store and present patient data was an EMR; I wanted to say "Amen, brother" -- at that point I felt like I was in a choir, in church!

I continue to be amazed at what other countries such as Spain are doing with EHR technology -- checkout this CBC news article; I keep wondering how soon we'll be able to best their efforts; maybe I need more patience...

Until next time, if you love soccer like I do, checkout the 2010 FIFA World Cup on CBC television -- the host country, South Africa, made a great start by scoring the first goal of the event -- a spectacular effort!

Photo credit: Ernest A. James and Heather Montague (Special Events Officer for the RVHSF), at the 3rd annual Pickering Rotary Ribfest.
Photo by: Jennifer Collins

Ernest A. James

President/CEO
Regal Informatics Inc.

e-Health -- CE LHIN going for gold!

2010-05-06T10:25:00.000-07:00

Last month I was invited to a store opening in Pickering at which time I had the opportunity to meet our 2010 Vancouver Olympic Silver Medalist, Shelley-Ann Brown, amongst others.
As you can see, I jumped at the first photo op I got and was also able have a short discussion with with her.
The impression I got was of someone dedicated to winning -- when not attending the various media events, or lending a helping hand (for example, with the Haiti reconstruction), you'd probably find her training hard for her next competition.
To me, she's not done until that gold medal's dangling...

This got me thinking about a comparison with our Local Health Integration Network (LHIN), the Central East LHIN (CE LHIN) -- you see, I'm yet to be convinced of the utility of inter-LHIN collaboration; to me, our LHIN's a huge bobsleigh team working to give the residents within its area of accountability, the most efficient healthcare possible. Sure, there are others (LHINs) in the Ontario healthcare system, so the whole idea is for the CE LHIN to acquire a place (and remain) on the podium for healthcare in Ontario.
I'd imagine that Shelley-Ann and Helen were aware of other competing teams from Canada -- I'd also hazard a guess that they weren't collaborating for ideas either -- they were too busy executing their own plan.
After the race (or at some other appropriate time), ideas may be exchanged, but during the competition, each team is sequestered -- the driver and the brake-person each concentrating on getting familiar with the nuances of the course.
So it should be with our LHIN -- we should be too busy trying to understand the unique requirements of residents to be involved with other LHINs, other than what's legislatively required.
Of course there will be opportunities for a meaningful exchange of ideas (for example, conferences and the like); Shelley-Ann and Helen probably had a discussion with the Kaillie Humphries/Heather Moyse team after the competition to ascertain what the latter did differently to win gold!

My point is that collaboration between LHINs may not be conducive to the proper execution of their respective mandates -- participants are predisposed to ensuring their "home team" comes off best; in Olympics parlance, I'm sure the Shelley-Ann/Helen team would rather win the gold medal and leave the silver for Kaillie and Heather!

Funny -- seems like the Premier McGuinty team may be thinking along the same lines because as I write, I'm hearing on the news that pay for performance is being legislated for Ontario hospitals: http://www.healthzone.ca/health/newsfeatures/article/803818--hospital-ceo-pay-to-be-tied-to-performance?bn=1 -- it'll be interesting to see what impact this has on inter-LHIN/hospital collaboration!

In the meantime, while I continue searching for ways to help improve the operation of my LHIN, I think I'll also check around to see if someone could come up with a functional neck brace/ornament for Shelley-Ann and Helen, 'cos wearing both the gold and silver medals simultaneously could sure end up doing some serious neck-muscle damage -- those medals are heavy!

Ernest A. James

President/CEO
Regal Informatics Inc.

e-Health -- retrospectively

2010-04-06T13:40:00.000-07:00

During a lunch session with a friend last month, it was suggested I restate some of the main points I have blogged about to date; thinking about the utility of the idea, I decided to do a "compare and contrast" on my current position vis-à-vis my first blog article.
What I've found is that although my strategy is still focussed on e-Health systems (Electronic Medical Records (EMRs), Electronic Health Records (EHRs) and Personal Health Records (PHRs)), I'm definitely blazing a new trail.

For example, I distinctly remember when I first started, I was all gung ho to set-up my office in Queen's Park (the Legislative Assembly of Ontario) and help enact new legislation mandating an EMR system in every doctor's office in the Province within a couple of years.
I soon realized this would be counterproductive, since doctors are not Information Technology (IT) specialists -- sure, the various organizations such as OntarioMD would be assisting procedurally and financially to set things in motion, but when the implementation party is over and the doctors are left on their own to manage the various aspects of their systems, the shine could disappear pretty quickly in a busy practice!
This could result in the necessary processes for backups, security, and software updates for the EMR system being given a low priority -- not a good thing if you want to maintain patient data integrity and privacy.
A rather severe thunderstorm struck the Greater Toronto Area (GTA) last summer; it convinced me that the Application Service Provider (ASP) model should be the way to go (this is where the vendor hosts the application and the doctor accesses it using a browser -- see my August 2009 article for more details) -- at least the burden for data security would be offloaded -- or so I thought!

I was derailed again late last year following my attendance at a seminar on the "OSCAR" EMR system -- someone made a comment to the effect that handing over the management of patient data to vendors could be akin to putting a kid in a candy store and expecting them not to be interested in sampling the wares; in other words, you can't expect vendors to have access to such a huge database and not be interested in legally selling it for research and marketing purposes.
So basically, I was back to square one -- the EMR system was back in the doctor's office...

However, a couple of months ago, I had an epiphany; it struck me that I did not maintain an E-mail system, yet I'm able to read my business/personal mail on a daily basis -- I simply use a browser to log on to the hosting company's web site (e.g. Google Mail) and manage my mail effortlessly and reliably via a process known as Software as a Service (SaaS -- see my February 2010 post).
It begged the question: Why can't healthcare providers have similar functionality without losing control of their patient data/privacy? Why shouldn't it be possible for your doctor to enter the exam room with say, a tablet (an iPad is an example of what's in the marketplace), sit next to you, tap the device a couple of times to access your healthcare record and start having a meaningful discussion, all without having to worry about the activity occurring behind the scenes?

This is where I'm at today -- my passion is now geared towards removing the management aspect of IT, but adding the functionality to enhance the provider/patient relationship.
In other words, we need to remove the computer hardware and it's associated software components from the front line of patient care (e.g. the exam room) and replace it with a non-intrusive mobile device that uses a simple web browser interface as an enabler to superb patient care.

The technology described above is available, so why are we still encouraging healthcare providers to become IT experts?
Well, a comment was added to my last article that I found succinct -- it was suggested that what we really need is political leadership!
With the size of the debt/deficit these days, I think it's only a matter of time.
We got off lightly this fiscal year (at least from a healthcare perspective) because elections are looming on the horizon, but watch out, 2012 may prove to be really interesting!.

Ernest A. James

President/CEO
Regal Informatics Inc.

e-Health -- integrated

2010-03-02T11:52:00.000-08:00

Oh Canada! What a country, eh! Whilst I was out earlier today (Monday, March 1st), I noticed many people walking around, chests puffed up like show budgies; no surprises there -- after all, we're coming out of a relatively mild winter, and one of the best Winter Olympic Games ever, has just ended -- what a way to start the year!
What's next, my favorite movie "The Hurt Locker" cleaning up at the Oscars, or a 10% increase for healthcare spending in Ontario for the upcoming fiscal year? Well, let's stay tuned!

As I promised last time, I'd like to spotlight integrated healthcare; based on an article that the Obama administration is said to have used on numerous occasions during recent discussions on healthcare costs. Although we do not have identical models of healthcare, I found the article a worthy discussion point.
It came about when Atul Gawande, did some research into why McAllen Texas is the most expensive place in the US, in terms of healthcare costs, yet it doesn't stand out for its quality in delivery.

Despite its length, I feel the article should be mandatory reading for everyone involved in healthcare delivery on the planet!

Mr. Gawande argues McAllen shows that:

an unhealthy population and high healthcare costs do not necessarily correlate
costs are inordinately high because people got more of the expensive stuff and not necessarily what's needed
there's an overuse of medical care -- health providers tended to maximize revenue
universal care is not feasible/sustainable unless costs can be controlled

He then goes on to suggest that the Mayo clinic-style of integration will be the future of universal healthcare; their tenet is: "the needs of the patient come first...", not the convenience or revenues of healthcare providers.

Two notable quotes for me are:

the most expensive piece of medical equipment, as the saying goes, is a doctor’s pen. And, as a rule, hospital executives don’t own the pen caps. Doctors do
when doctors put their heads together in a room, when they share expertise, you get more thinking and less testing

Recent events have me questioning where we're really heading, healthcare-wise, in Canada; for example, the media on both sides of the border jumped on the story of Newfoundland's Premier Danny Williams' trip to Florida for a heart procedure -- it was even referred to during President Obama's televised health summit.

It begs the questions: does this reflect on the quality of our healthcare? Are we at the two-tier stage where if you can afford to, you can get better care, faster, elsewhere?

I agree wholeheartedly with Atul Gawande's argument that the Mayo clinic model of healthcare (that of integration) has got to be our beacon for the future, if universal healthcare is to survive.

Admittedly, it has piqued my interest mainly because one of the underpinnings is the use of Information Technology (IT) to share everything -- patient information, expertise, ideas etc.

That's it for now and until next time, perhaps you should start working on mothballing the snowblower and preparing the lawnmower, hedge-trimmer and golf swing -- won't be long now!

Article: http://www.newyorker.com/reporting/2009/06/01/090601fa_fact_gawande?currentPage=all

Ernest A. James

President/CEO
Regal Informatics Inc.

e-Health -- the shoe-maker needs new soles, part 2

2010-02-01T08:25:00.000-08:00

Let's continue the discourse begun last article by considering the following statement:

The current Canada Health Infoway/OntarioMD Electronic Medical Record (EMR) systems strategy is flawed.
The above-noted organizations support doctors installing their favorite EMR application on their computer systems, be it from vendors such as xwave, Practice Solutions, Nightingale or the Open Source product, OSCAR -- heck, the two organizations even go as far as to fund the process!

The fundamental question that's been avoided is:
... does your doctor really have the required resources (time/expertise) to maintain his/her system?
Let's take a hard look at some of the things that are required on a regular basis; your doctor needs to:

ensure the system is secure
ensure daily backups are successfully completed
ensure these backups are rotated off-site in case a catastrophic event occurs
ensure the hardware systems in the exam rooms are maintained
ensure tested procedures and resources are available to rebuild following a catastrophe

The list goes on...

To be honest, although these stand-alone applications do an excellent job, I'd much prefer my doctor taking the time to master the relationship between good nutrition and health, as opposed to delving into the intricacies of maintaining computer systems.

Sure, your clinic may be able to fund Information Technology (IT) resources (take for example, the Oshawa Clinic), or your doctor may have gone the "Application Service Provider" (ASP) route whereby the system is located at the Ministry of Health data-center with clinic staff connecting through a browser; however there still remains the fact that all they've done is to automate an island of information; if all health provider offices in the Province were EMR'd, (in-house or ASP), they'd still be inaccessible by other clinicians -- we'd still have:

instances of hospitals not being able to discharge patients because critical health information is locked up on some hard drive
letters of apology being sent to individuals when computer systems (or components thereof) containing health information go missing
doctors not knowing in a timely manner when their patients have been admitted/discharged to/from the hospital
no efficient means of summarizing health data for trending/funding exercises by the Ministry of Health and Long Term Care (MOHLTC)

In other words, we'd still be missing the infrastructure to link these automated islands of information!

I can almost hear the question:
OK, you've always been a proponent of EMRs -- what's going on? What alternative do you suggest?
Glad you asked -- well, what we need each of our Local Health Integration Network (LHIN) organizations to do, is host an EMR system as a "Software as a Service" (SaaS) application -- the latter is where a hosting company provides the services of any application (could be EMRs, mail or Microsoft Word/Excel/PowerPoint functionality) accessible via a browser; this could be funded either by ad revenue or by a direct charge to the user on a time/use basis.
To read my E-mail, I log on to Hotmail or GMail via a browser -- I don't really care where the servers are located -- I just expect the mail service to be available; there's no need for me to be concerned with backups, updates to mail programs and the like -- that's all taken care of by the hosting company. If there's a an outage, a need for an update to be applied, a catastrophic event -- no problem -- I just sit back, relax and wait until the service becomes available. Why shouldn't our EMR systems follow a similar process?

Picture the situation whereby each LHIN runs it's own data-center and serves up a SaaS EMR accessible through your favorite browser! Every authorized clinician (doctor, nurse, paramedic, specialist etc.) around the globe now has access to the same patient record! Eureka!
My point is that generally, doctors don't do their own accounting, they don't service their own vehicles or their office equipment; so what's so special about IT?
When a police officer pulls you over on the highway, s/he just needs your documents to access your personal/vehicle record -- surely healthcare should be no different -- my health is just as important as my security!

To those doctors who have so far controlled the urge to implement an EMR system, I applaud your prescience; with the advent of netbook computers sans Microsoft Windows, the Apple iPad and similar tablet offerings from other manufacturers, something's gotta give pretty soon!
Let someone else look after the IT work in the back-end -- you concentrate on the front-end, i.e. the best patient care possible.

Next month we'll discuss integrated health care -- a process that's working very well in the US; in the meantime I'll let you get back to organizing your Super Bowl party. Be safe and enjoy!

Ernest A. James

President/CEO
Regal Informatics Inc.

e-Health -- the shoe-maker needs new soles

2010-01-06T07:29:00.000-08:00

I hope you had a wonderful holiday and the effects of L-tryptophan have long since dissipated; so now you're ready for the Ontario Winter Games -- you know the ones where you compete to see who can get the longest slide on black ice without falling, who can throw snow the farthest clearing up after a storm, or who can clear the snow jammed into driveways by the plow, the fastest.
Winter's upon us, obviously, and I sure didn't miss the irony of the situation after I'd just purchased fuel in -25 degree wind-chill weather and my favorite singer Dee Dee Bridgewater begins singing the song "Cherokee" with opening lyrics of "Dreams of summertime..."

Anyway, apologies to those readers living outside the boundaries of the Central East LHIN (CE LHIN) -- the posts for January and February may not be as generalized as previous articles; I'd like to suggest however, that what's discussed is by no means unique.

I received a "December-update" alert from the CE LHIN concerning current e-Health projects and the following items really piqued my interest:

the Hospital Information System (HIS) being terminated due to a lack of resources -- this project appears to pertain to CE LHIN data consolidation standards; I presume this means the end of the project, since it's obviously inappropriate to continue the next phase if the previous one is incomplete
a business case to consolidate 33 hospital data-centers will be presented to the various CEOs at an all-day session in our region -- I also presume the CE LHIN is spearheading this
the CE LHIN is joining forces with 5 other LHINs to develop a Patient Health Information (PHI) system that will enable data sharing
we're also involved in a Resource Matching and Referrals (RM&R) project with 7 other LHINs whereby information will be shared between the various "Care" centers

I received another alert shortly thereafter informing me that the Peterborough Regional Health Center ("a cornerstone of our LHIN" as per the Chairman of the CE LHIN's Board), after being in a deficit position for the past 13 years, is this time projecting a $35 million whopper for the 2010/2011 season.
Things have gotten to the stage that the LHIN is sending in a peer review team to fix the situation!

To me, the above begs the question: Why are we involved in so many projects with non-CE LHIN participants (and terminating internal ones) when our infrastructure is tumbling, or about to?

I'm suggesting the CE LHIN, at a minimum, consider the following options:

all projects involving other LHINs be mothballed -- let's hunker down and get our house in order -- let the shoemaker have a chance to re-sole his shoe, so to speak
get our LHIN's hospitals' data-centers consolidated within the region and change the way we pay for and use software; this will not only save huge amounts of money on the licensing front, but will also facilitate information sharing (think EMRs/EHRs) -- the current lack of which I feel is a big contributor to the ongoing deficits

At this point, I'd like to hold the discussion until next time when I'll get into more details.

Think the above is a tad unworkable? Well, let's get your ideas/comments posted -- we're gonna need all hands on deck; the next couple of years will no doubt be painful since budget cuts (which inevitably translate to service reductions) will be an ongoing reality, but if we do things right we could come out of this with a much more efficient operating model that can be proudly shared with other LHINs.

Wishing us all a safe, healthy, challenging but productive year ahead.

Ernest A. James

President/CEO
Regal Informatics Inc.

e-Health -- security unplugged

2009-12-01T07:06:00.001-08:00

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

2009-11-03T06:56:00.000-08:00

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

2009-10-07T10:26:00.000-07:00

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...

2009-08-28T10:34:00.000-07:00

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...

2009-07-31T05:42:00.000-07:00

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 ...

2009-06-30T07:24:00.000-07:00

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?

2009-05-27T13:15:00.000-07:00

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!

2009-05-03T14:17:00.000-07:00

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

2009-04-02T12:48:00.000-07:00

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...?

2009-02-21T12:51:00.000-08:00

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?

2009-02-02T10:14:00.000-08:00

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

2009-01-09T08:45:00.000-08:00

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.

eHealth -- the adventure begins...

2008-12-19T14:09:00.000-08:00

Just imagine -- going to work on a beautiful day then suddenly, out of the blue, you're entangled in a mass of twisted metal -- you've just been involved in an accident and between the lapses into/regaining of un/consciousness, all you can hear is the screaming of sirens and the jarring of metal as emergency personnel work feverishly to separate you from your vehicle.

Finally, you're lying on a stretcher in the middle of the highway as ambulance technicians try to get your attention to ascertain what allergies you may have etc., but you just wanna sleep because although the pain is crushing, everything seems so surreal.

Far-fetched? You may be forgiven for thinking that way, but the above scenario plays out many times per week on the roads here in Ontario; of course there are many other types of emergencies, but if one were to happen to you, wouldn't you like to know there's a system in place whereby emergency personnel can access your medical records almost instantly using your vehicle license plate or identification on your person or in your bag and the Internet? Proper treatment could then be administered asap.

Well folks, such a system is imminent, whether we're aware of it/whether we agree with it, or not; architecturally it comprises of the system your health provider(s) keep(s) in the office (an Electronic Medical Record -- EMR) and the part that's managed by the Province (an Electronic Health Record -- EHR).

Together, the EMR/EHR will soon become an integral part of the life of each person in Ontario in an effort to make health care in the Province (and eventually throughout Canada) more efficient, both from a cost and quality perspective.

Hello, I'm Ernest James, President/CEO of Regal Informatics Inc., a nascent company in Whitby, Ontario. We're passionate about the potential of EMR/EHR systems and you're invited on a journey (blog-wise) to educate ourselves and those we come in contact with (family, friends, health providers etc.) to help bring about the best health care possible in Canada, one community at a time.

I'm gonna let you mull this over (between bites of turkey and your favourite beverage) then come back at you early in the new year to continue the journey -- there's so much to discuss, for example (but not limited to):

* what started all this -- a personal perspective

* a basic intro to the EMR/EHR

* implementation time frames

* what our friends in the US are doing/potential impact on Canadians

* security

* who pays for what

* functionality

* concerns

* what role you can play

In the meantime, feel free to say your piece (by clicking on "comments" below) and bring others into the discussion.

So until next time, Seasons Greetings and watch how you go.

Ernest A. James