Healthcare funding

I just finished reading a good article on the future direction of healthcare services funding in Alberta.

http://www.edmontonjournal.com/health/Alternate+health+care+funding+explored/2241802/story.html

Unlike most of my other posts, this has little to do directly with eHealth.  Healthcare spending policy is an important issue that will have an enormous impact down to road for all things eHealth. Health Minister Liepert made some interesting comments at the Alberta Association of Municipal Districts and Counties on Thursday. Looks like Alberta is on the fence about privatizating more of their system. According to the article, Albertans want to make sure health care spending levels are protected and the govt seems to be considering ways to do this. Nothing is set in stone, but the Alberta govt seems to be floating some trial ballon ideas to gauge the public response.

Healthcare spending is consuming a greater percentage of all govt spending every year and it has been outstripping inflation for a long time now. At what point do provinces have to start privatizing more of the system? Assuming Alberta privatizes more, I think all the other provinces will follow their lead….what other choice to do they have if the public demands healthcare service levels and spending remains high?

Mark

Tapping into the “e-Patient”

One of my favourite sources of information on Consumer eHealth is Pew Internet.  They regularly research the impact of the Internet in various of aspects of everyday life including health.   Given the tarnished “eHealth” brand, I think that there are some powerful messages from a recent Pew Internet study:

http://ehr.healthcareitnews.com/blog/e-patients-plugged-and-waiting-1

Citizens, in my view, are ready, willing, and able to use the Internet to research health related topics.  I strongly suggest that the eHealth community (including gov’t policymakers) make better use of the Internet to inform and to gather feedback regarding eHealth plans and to demonstrate the value that investments to date are delivering.   Check out the Pew Internet study as it contains some detailed data on use of the Internet for health related purposes.

Mike

 

Canadian eHealth Policy

In his first article on the Canadian eHealth agenda Bill Pascal suggested that “we need to resolve many policy issues”.  I am going to go further and state that we need to create an organization at the national level charged with creating and driving Canadian eHealth policy.  Many other countries, including the US, have created such an organization and their leaders are providing critical leadership and visibility with respect to their country’s eHealth agenda.  While Infoway is a vital and important component of the Canadian eHealth landscape, it was not intended to be a policy organization.

What do other people think?  How do we best drive resolving the many policy issues associated with eHealth in Canada. What, in your opinion, are the key policy issues that need to be resolved?

Mike

 

Let the discussion begin

Bill Pascal, the Chief Technology Officer for the Canadian Medical Association, published the first in what he plans to be a series of articles on the Canadian eHealth agenda in Health Information Management & Communications Canada – the journal of COACH, the Canadian health informatics association. (5 – Reflections on an Agenda William Pascal).  A number of people provided Bill with input and feedback including me.  We’d like to solicit input on Bill’s thoughts and suggestions and will use this blog as one vehicle to do so.  To stimulate debate we will publish blog posts on various topics related to the Canadian eHealth agenda.  You can contribute by either commenting on these posts or by writing post of your own on which others can comment.  If you are interested in publishing a blog post as a guest author please contact me michael.martineau@rogers.com.

Let the discussion begin!

Mike

QHR buys CLINICARE

It doesn’t take a PHD to see consolidation happening in the Canadian EMR vendor marketplace.  Scores of small(ish) vendors competing in a hyper-regionalized market of about 65K physicians. The question is does the recently announced purchase of CLINICARE by QHR (and sub Optimed) represent the first stage of mass market consolidation or is it a one off?

The questions I am asking myself are:

• Did QHR do this for an OntarioMD certification and entry into the US, or am I missing something?
• Which vendor will sell next?

The big issue (for me) that has always slowed a natural market consolidation in this space has not been on the seller side but on the buyer side. There are few EMR vendors that have the interest or financial muscle to buy 2-3 of their competitors. Why buy a small vendor for their install base, if you can try and convert their users to your product for a fraction of the cost. Unless an acute vendor or large multinational gets an EMR itch they have to scratch, I can’t see any of these guys acting as a consolidator.

I can only imagine the reaction amongst EMR vendors that are facing a declining market position (for whatever reason)…do we sell now while we can or do we really think we can survive in this market? Not an easy decision, as I doubt many vendors will get a premium valuation for their company.

Mark

 

 

 

Failure is an Option

One of the life lessons that I have tried to teach my kids is the value of learning from your mistakes. I frequently remind my daughter of Thomas Edison’s famous quote when, after numerous failures in developing an electric light bulb, he was asked if he was ready to quit.  Edison replied

“I have not failed. I’ve just found 10,000 ways that won’t work.”

Another quote that I have shared with her and even printed a copy to hang above her desk is from Winston Churchill

“Courage is going from failure to failure without losing enthusiasm.”

More recently, I was struck by President Barak Obama’s view on failure:

“Making your mark on the world is hard. If it were easy, everybody would do it. But it’s not. It takes patience, it takes commitment, and it comes with plenty of failure along the way. The real test is not whether you avoid this failure, because you won’t. it’s whether you let it harden or shame you into inaction, or whether you learn from it; whether you choose to persevere.”

I was reminded of my many discussions with my children about failure and mistakes when I read the federal Auditor General’s report on Canada Health Infoway.   Although I wholeheartedly support and endorse Canada Health Infoway, I have long felt that they don’t  share failures or anything less than positive news.  Given the number of investments that they are making it is not reasonable to assume that they will all be roaring successes and, given the statistics on IT projects across all industries, we can expect a number of failures and only partial successes.  How are we communicating these lessons learned from these failures?  In this current era of eHealth “scandals” no sane person would want to risk media attention by admitting that IT project for which they were responsible had failed.  Too bad.  If we want to get the best return on our investments I think that we need to openly share all lessons learned and to admit, without fear of recrimination, when something goes wrong so that other can benefit.  Failure is indeed an acceptable option provided that we learn from it.  Otherwise, we have squandered our investment and have not generated any value for the money spent.

Mike

Infoway audit results

Wow!

The results are in and it looks like Infoway got a passing grade from the AG. It is interesting to see the scope (focused on only the 5 core EHR blueprint components) and results from the report. I’m glad there is no lurking scandal that would derail wider support for eHealth in Canada, but I’m a little disappointed on the limited scope of the audit. If you are going to give CHI a passing grade, their credibility would be greatly enhanced if this also focused on all their net new initiatives (ie Consumer, EMR, etc).

The elephant in the room for me (to get to a higher level of automation) is still on radically increasing EMR adoption and real use by Canadian physicians. If 80% of the interaction for Canadians is with their physician, then how is CHI doing in regards to this effort? I realize that CHI have only recently starting focusing on this segment, and some would argue that it is too soon for the AG to comment. I would disagree due to the importance of getting the EMR piece right. Getting this right or wrong is going in determining whether we are closer to 17%  or 50%.

What does everyone else think?

Mark

New OntarioMD funding announced

Well, finally some good news for eHealth in Ontario:

https://www.ontariomd.ca/portal/server.pt?space=CommunityPage&cached=true&parentname=CommunityPage&control=SetCommunity&CommunityID=566&PageID=1787

Although long anticipated, new funding for physician office EMRs is an important component of the Ontario eHealth strategy. With all the talk about budget cuts and the delays to Infoway funding, I am very pleased to see the Ontario government commit to getting family physicians on-line. Given that nearly 80% of all healthcare interactions take place with a family physician, getting the health records associated with these visits in electronic form is a critically important step.

Mike

Waiting for the Infoway Audit Results

Ever since the eHealth Ontario scandal broke in mid-2009, the question I keep getting asked is “What about Infoway? Is there a scandal within this organization?” To date it has undergone quite a few audits, and has had few (if any issues) come up. On Nov 3rd, a larger report from the AG Sheila Fraser will give us some answers.

If you believe half the press or bloggers out there, things will not go well for them. I believe this general public mood has been directly created by the eHealth Ontario scandal. The public is not in a good mood about all things eHealth, and will not be happy about the perceived progress/value for money to date. Infoway set the target of 50% automation of health records by 2010, and by their own admission have only reached 17% automation…all at a cost of nearly $2B. Infoway has a public perception credibility gap of their own creation.

Some of the questions I am asking myself is:

• Should the Feds fund some or none of the $500M by next April?
• If 50% by 2010 was not realistic, then what is the next target? How do get to this target, and how do you measure it?
• What reforms (if any) are going to be suggested by the AG?
• If Infoway gets thrown under the bus, how else do we move the larger eHealth agenda forward?

I guess I will have to sit and wait just like everyone else to see the results from the AG report.

Mark

Here we go again?

The media is starting to bang the war drums about the upcoming Federal Auditor General report on Canada Health Infoway due out next week

http://www.northumberlandtoday.com/ArticleDisplay.aspx?e=2146961

I sure hope that there are no major skeletons in the closet and that we can have a meaningful discussion on progress achieved and value for money.

Mike