Dr. El Emam will speaking at the monthly OCRI IT in Healthcare lunch event on Friday, January 20th.  Dr. El Emam will be talking about conduct surveillance of individuals for public health purposes while providing strong privacy guarantees.    This secondary use of information collected to treat individual has considerable value and is used for various purposes such as monitoring for infection or disease outbreaks, evaluating the effectiveness of vaccines, drugs, and medical devices, and detecting fraud or abuse.

In addition to getting to hear what I know will be an informative talk you will also have the opportunity to network with others in the Ottawa area with an interest in the application of IT in the health sector.

More details here.

Mike

P.S. In the interest of full disclosure I co-chair the program committee.

Here’s an excerpt:

The concert hall at the Sydney Opera House holds 2,700 people. This blog was viewed about 25,000 times in 2011. If it were a concert at Sydney Opera House, it would take about 9 sold-out performances for that many people to see it.

Click here to see the complete report.

Learn from other industries.  While healthcare, like other industries, has unique characteristics, it also shares many similarities.   Since many other industries are further advanced in their use of information technology and in managing the digital information that they collect,  they offer many lessons that can be applied to healthcare.   I encouraged the students to seek out these lessons and figure out how they might be applied to the delivery of healthcare services.

To make my advice more concrete, I cited The Ottawa Hospital as an example of an organization that is actively seeking best practice examples from other industries.  For starters, The Ottawa Hospital’s CIO, Dale Potter, was hired specifically for his experience in other industries.   In turn, Dale has engaged organizations outside the health sector and created learning opportunities for his staff.  One such organization is Nav Canada, the agency responsible for air traffic control in Canada.  According to Dale, Nav Canada’s focus on moving people safely through the skies is similar in many ways to ensuring optimal patient flow through a hospital.

Listen and Observe.  Mark Douglas, co-founder of this blog and my frequent sounding board, likes to remind me that God gave us two ears and one mouth and that we should use them in that ratio.   Effective IT professionals in any industry are the ones that learn the business in which they work and figure out how to make IT useful to the organization and the people that work there.  I encouraged the class to take the time to listen to and observe the people delivering healthcare services and to work with them to figure how IT can make the most impact in their day to day activities.

Technology Drives Strategy.  My final piece of advice was, admittedly and quite purposefully, intended to buck what I see as a commonly accepted practice in healthcare IT.   I have heard numerous presentations over the past year make that the case that  business strategy and objectives should drive IT plans and architecture.  While I don’t argue that the merit of this seemly prevailing viewpoint, I think that it ignores the often disruptive nature of continued technology evolution.

Technology can and does drive business strategy.  Hence, I believe that one of the important roles of the healthcare IT professional is understand the possible impact of technology evolution on business strategy and to help the organization understand how it can take advantage of technology developments.  IT will drive business strategy as much as business objectives will drive IT strategy, whether an organization likes it or not.

Mike

Mike

On October 5th, we are teaming with COACH, the voice of Canada’s health IT professionals, to host a special one-day conference that brings the local health and IT communities to explore ways that these two communities can work together to develop innovative health IT solutions.   This unique event will focus on practical and affordable applications of health IT that address today’s healthcare challenges and offer near-term benefits.

Whether you have an idea for a new application that you think will benefit the local health sector or  want to share your challenges with people who can offer a fresh perspective, please join us on October 5th.     I look forward to seeing you there.

You can find more details here.

Mike

comunityies

OCRI, the voice of the Ottawa R&D community and COACH, Canada’s health informatics professions, have joined forces to host a special one-day event

I posed a number of questions related to the use of health IT, the future of eHealth Ontario, and the Minister’s thoughts on LHINs.  Of the various questions that I posed, the moderator selected my question about eHealth Ontario.  I asked the Minister about whether eHealth Ontario would continue to exist under a Liberal government.  Minister Matthews replied:

“Anyone who works in health care knows that we need to continue to transform it unless we want to move to two-tier health care, which Ontario Libs certainly don’t!! A vital part of that transformation is moving forward with eHealth. We’ve now got about half of Ontarians with EHRs – shutting down eHealth would be just dumb!”

As the minister did not directly refer to eHealth Ontario, it is not clear whether she was stating a commitment to the agency or to continued investment in eHealth.  Perhaps “eHealth” was intended as short form of “eHealth Ontario” or maybe she was being purposely vague.  Whatever the case, I am pleased to see the Minister recognize the role that health IT can play in transforming our healthcare system.

Mike

• 7,000 out of 10,000 physicians are adopting EMRs.
• An increasing number of physician offices are receiving data in electronic from (e.g discharge summaries) from hospitals through a number of initiatives.
• 100 hospitals have digital imaging and exchange capability with more coming online.
• 2,400 out of 3,000 head trauma pts not transferred from smaller hospitals to larger hospitals based on specialist recommendations provided through the Emergency Neurosurgery Image Transfer System.

The main portion of the presentation was delivered by Fariba Rawhani, VP, Architecture and Planning.  She unveiled the eHealth Ontario 2015 Blueprint to a sold out room of health IT vendors. Ms. Rawhani did an admirable job, in my view, of putting the various elements of the blueprint into perspective and highlighting what she felt were the core themes of the blueprint.  Overall I found her engaging and interesting.  HOWEVER, I did, for the following reasons, take exception to her plea that the audience bear with her as the material might be a little dry:

• It is the presenter’s job to make the material interesting.
• There was a roomful of people who paid to hear about the latest developments at eHealth Ontario and who have been waiting a long time to hear about a new strategy.   I watched many people furiously scribbling notes … clearly the material was far from dry for them!
• Implied that architecture / technical information of this nature is necessarily dry.  Why do many senior executives seem to put down technical information in this way?

My main takeaways from this presentation include:

• Blueprint was developed after extensive consultation with a wide variety of stakeholders and is aligned with the Canada Health Infoway blueprint.
• Blueprint takes into account the reality that 80% of healthcare is delivered at the community level.
• Blueprint balances local discretion with shared direction.  It is intended to be thoroughly planned, not thoroughly prescriptive.
• EHR 2015 is a journey, not a destination.
• The blueprint:
• provides a framework for collaboration
• defines the scope of EHR (eHealth Ontario plans to have a foundation in place by 2015 but won’t try to “boil the ocean”)
• specifies a federated approach to creation
• establishes governance that will lead to higher probability of successful delivery
• defines a standards-based architecture which eHealth Ontario hopes will become an open platform for innovation
• will reduce duplicated / wasted investments and increase speed of deployment
• enables operational high availability

• Health data is collected and stored at the organization level such that we have a fragments of patient data scattered across multiple facilities that cannot be easily assembled into a consistent, aggregate electronic health record.
• There is a significant investment in “legacy” systems that in many cases meet the needs of the organizations and users that they serve.
• The main theme of the blueprint is “connectivity”.   eHealth Ontario believes that a major problem facing Ontario is not lack of data in digital form but an inability to share that information among healthcare providers.  They want to create the “Interac” for health care information.
• Assembling a composite patient record by retrieving information directly from the collection of heterogeneous point of care systems is impractical.  Hence, the EHR architecture described in the blueprint is based on central registries and repositories.
• Key design principles influencing the EHR architecture:
• Create consistencies
• Amalgamate information
• Assure security and privacy
• Accessible to those who need it in a timely manner
• Four distinct categories addressed by the blueprint:
• Connectivity and integration
• Security
• Privacy
• Data governance
• The architectural vision is to
• Foster an ecosystem in which many partners can innovate and share services and capabilities.
• Enable clinicians, citizens, EHR, and healthcare facilities
• The EHR architecture specified in the blueprint consists of three layers:
• Point of Service applications (generally supplied by health IT vendors)
• eHealth hub services (layer at which eHealth Ontario expects that most innovation will occur)
• Provincial eHealth services
• The eHealth hub services will be deployed at three regional hubs plus a provincial hub. The regional hubs serve:
• Northeastern Ontario (23% of the population)
• Southwestern Ontario (29% of the population)
• GTA (48% of the population)
• Many EHR related initiatives will take place at the regional hub level and will be driven by leaders at this level.  eHealth Ontario will provide funding and resources and delegate the required authority.
• Privacy was mentioned several times during the presentation as a critically important consideration.   Key elements of the eHealth Ontario Provincial Privacy Program include:
• privacy by design
• training and education
• eHealth Ontario feels that governance is a critical success factor and that governance and privacy, if done correctly, can be accelerators
• Data exchange / interoperability will be achieved through adherence to standards.  To the extent possible, preference will be given to international standards.  eHealth Ontario recognizes that the more global the focus, the more attractive Ontario will be as a place for vendors to innovate.
• eHealth Ontario support includes:
• Standards
• Governance
• Capacity building
• Funding
• Other mechanisms as required
• Key eHealth Ontario led initiatives include:
• Logical architecture
• Governance
• EHR asset inventory
• EHR roadmap
• Communication and training

Not surprisingly, I was pleased to hear several references to a healthcare ecosystem and an emphasis on innovation fostered by standards.  The architecture appears to allow providers to continue to choose Point of Service applications that meet their particular needs and to allow vendors to continue to innovate at this level.

eHealth Ontario stated that they were still tinkering with the blueprint but hoped to have a 100+ page document release “very soon”.   I look forward to reading all the details and engaging in discussions with my many readers and contacts.

Mike

Mike

Seems that my Dad, who turned 76 years old this year and only purchased his first computer when he was in his late 60′s, is not alone among the older generation in their interest in tablet computers.   Indeed, a recent survey by QuantiaMD reveals that older physicians (those who have been in practice 31 years or more) are about as likely as those just out of medical school to own a tablet computer or plan to purchase one. According to the QuantiaMD survey:

•  19% of doctors in practice 31 years or more use a tablet in their work.
• 25% of doctors in practice 31 years or more indicated that it’s extremely likely they will get one in the future.
• 20% of doctors in practice less than 10 years use a tablet.
• 38% of doctors in practice less than 10 years indicated that it’s extremely likely they will get one in the future.

An American Medical News article cites the views of several older physicians about tablet computers:

• Dr. Frank Kempf,  a 58, year old cardiologist at Pennsylvania Hospital in Philadelphia, notes that the “The learning curve of the device is quite advantageous.”
• Dr. W. Randolph Chitwood, a 65 year old director of the East Carolina Heart Institute at Pitt County Memorial Hospital and East Carolina University in Greenville, N.C., believes that the tablet computer will replace the laptop in hospitals and physician practices.  He has even had a seamstress sew what he calls an “ipocket” into his lab coat.
• Dr. Steven Rothenberg, MD, a 52 year old chief of pediatric surgery at the Rocky Mountain Hospital for Children in Denver, stated that “The biggest thing is, as a physician, we are dependent on information to function. And anything like the combination of GCQ and mobile that gives us information in a faster and easier way is so good and relatively straightforward.” (Note, Global Care Quest (GCQ), an iPad application developed at the University of California at Los Angeles, provides remote access to patient data)

So, perhaps older physicians don’t have the fear of technology that many people seem to think.  Rather, they may just be better at determining what is truly useful technology.

Mike

Mike