Tag Archives: eHealth Ontario

Procurement Meets Moore’s Law

The following is an article that recently appeared in Healthcare Information Management & Communications Canada magazine:

My father, the consummate bargain hunter, has never heard of Moore’s Law.  Yet, on a regular basis, he takes advantage of the falling prices that are one its inevitable consequences.  My father has learned that he need only wait a couple of years after a new technology is announced for the price of products based on that technology to drop to the level he is willing to pay.   Paradoxically, the same rapid changes in technology that benefits consumers like my father may, in the context of long government procurement cycle, stifle innovation and lead to failed health IT projects.

In a 1965 paper, Intel co-founder Gordon Moore noted that “the complexity for minimum component costs has increased at a rate of roughly a factor of two per year” and predicted that this “rate can be expected to continue”.  This prediction became known several years later as Moore’s Law and has been the source constant innovation in the IT sector for more than half a century.

The impact of long procurement cycles on IT related procurement has been evident in the defence and aerospace industries from quite some time.  A 2006 book on C4ISR (Command, Control, Communications, Computers, Intelligence, Surveillance and Reconnaissance) for future naval strike groups prepared by the U.S. Naval Studies Board concludes:

“The current procurement process of the Department of Defense concentrates on buying ships, airplanes, tanks, and so on. Most of these items have lives that are measured in decades, with few major upgrades over their lifetime. Information technology is changing on the time line articulated in Moore’s law and does not fit into such a process.”

Closer to home, an article in Vanguard, a Canadian defence and security magazine notes:

“Today, the emphasis in federal government procurement is on inputs, with detailed specifications of what, in IT, are constantly moving targets.”

This same article quotes Kamel Shaath, chief technology officer of Kanata-based KOM Networks.  Mr. Shaath contends that “procurement even is inhibiting innovation at times because they [government agencies] are not able to take advantage of new technology.”  Mr. Shaath recommends:

“We need to foster innovation and to have procurement processes that allow the government agencies to embrace and adopt new technologies on a much more rapid pace.”

At the 2012 eHealth conference that took place in Vancouver earlier this year, the opening key note speaker, Dr. John Halamka, was openly critical of the processes used to procure health IT systems and claimed that these practices stifle innovation.    In a blog post written soon after the eHealth conference, Dr. Halamka asserts that “Traditional procurement approaches are likely to acquire technology at the end of its lifecycle.”

While procurement reform is certainly a hot topic, it will, by its very nature, take time to happen.  In the meantime, we might want to consider the advice of Chris Gunderson, a Research Associate Professor of Information Science at the U.S. Naval Post Graduate School and a retired U.S. Navy Captain.  Driven by what he call his “frustration at us Good Guys’ inability to get out of our own way when it comes to acquiring and applying to technology”,  Professor Gunderson is devoting the latter part of his career to “co-opt the government bureaucracy to consume my lessons learned about successful distributive, collaborative e-Biz ‘best practices’ in-spite of itself.

In an October 2009 interview with Ubiquity magazine (an Association of Computing Machinery publication) Chris Gunderson makes a similar case regarding the challenges of IT procurement in the face of rapid technological advances as others quoted in this article:

“The downside of all these restrictions is that the time for the government to procure and deliver a major system is easily a decade or more. With the environment of use changing at the rate of Moore’s Law, the delivered systems are almost always obsolete or obsolescent.”

While acknowledging these challenges, he offers hope that they can be overcome:

“I’ve learned that the best way to achieve powerfully disruptive change is by subtly co-opting the existing processes. By “co-opt” I don’t mean anything subversive or underhanded. I simply mean we should introduce more convenient and efficient methods within the constraints of the existing bureaucratic requirements. The improvements will be adopted because they are perceived as both comfortable and useful.”

Mike

eHealth Ontario Update

Having written about eHealth Ontario’s decision to scrap the Diabetes Registry – one of the agency’s more high profile projects judging by CEO Greg Reed’s references to it during his first year – I was curious to learn more about the state of other eHealth Ontario projects. Since I was having difficulty tracking down up-to-date information on these other projects, I jumped on the opportunity to hear Fariba Rawhani, Senior VP Development and Delivery, speak at the recent itHealthcare conference sponsored by HIMSS Ontario. Since Ms. Rawhani’s presentation is unlikely to be made publicly available, I decided to share what I heard and managed to write down in my monthly “Technology for Doctors” column.  Check it out here.

Mike

Ontario Diabetes Registry – Doomed from the start?

Over the week several readers of my blog, eHealth Musings, have asked me to comment on eHealth Ontario’s recent decision to terminate its contract with CGI to build an electronic Diabetes Registry.  Check out my article on this topic at Technology for Doctors.

Mike

Did the eHealth Ontario 2015 Blueprint See Its Shadow Today?

Since I often leave for work before the sun rises in the winter, I didn’t hear whether the groundhog saw his shadow today until after I sat at my desk. In fact, I didn’t hear about it so much as I read about it on twitter. Realizing that it was Feb 2nd, I pondered whether the eHealth Ontario 2015 blueprint document, like the groundhog, had made an appearance.  If it did it must have seen its shadow and scurried back in its burrow because I can’t seem to find it anywhere!

Last year I attended several public forums at which senior eHealth Ontario executives spoke about the new eHealth Ontario 2015 blueprint. The first event was an ITAC Health sponsored vendor forum at which Fariba Rawhani walked a packed room through a detailed overview of the blueprint; you can read my blog post on this event here. At the end of her presentation Ms. Rawhani promised that we would see a 100+ page detailed blueprint document “real soon”.

In early October I co-chaired an OCRI sponsored one-day eHealth partnership and innovation forum in Ottawa at which Ms. Rawhani once again spoke about the blueprint and once again promised a more detailed document would be released “real soon”. Thinking that perhaps the delay was imposed by events outside Ms. Rawhani’s control, I publicly asked Greg Reed when the blueprint document might be released when he spoke at an eHealthAchieve breakfast in early November. His initial answer was – wait for it – “real soon!” He then qualified his answer with “by the end of the month”. Perhaps I should have asked him “which month?” or “what year?”.

So, now it is 2012 and Ican only find one reference to the blueprint on eHealth Ontario’s web site. It is a copy of a one-page blueprint diagram on the vendor relations page.

Unlike the proverbial groundhog, no one seems to know what has happened to the eHealth Ontario 2015 blueprint document.  Given that lack of a strategy beyond 2012 was a major criticism leveled by the Auditor General more than two years ago, I am left to wonder why there hasn’t been more urgency given to releasing the blueprint document.

Mike

2011 in review

The WordPress.com stats helper monkeys prepared a 2011 annual report for this blog.

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.

“Shutting down eHealth would be just dumb!” – Minister Deb Matthews

Earlier this week the Ontario Liberal Party hosted an on-line text chat with the Minister of Health and Long Term Care, the Honourable Deb Matthews.  The session was moderated, with the audience posing questions to a facilitator who selected the questions for the minister to answer.

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

 

 

eHealth Ontario 2015 Blueprint – My Impressions

As mentioned in yesterday’s blog post I attended an eHealth Ontario vendor information system hosted by ITAC Ontario on July 26th in Toronto.   Greg Reed, eHealth Ontario CEO, opened the presentation with a brief summary of notable agency accomplishments, including:

  • 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

 

eHealth Ontario – 2015 eHealth Blueprint – 1st look

I attended an ITAC Health hosted event this morning at which eHealth Ontario presented a 1st look at Ontario’s 2015 eHealth Blueprint.  I’ll comment on what I heard in a separate post but, for now, I thought that I’d share a copy of a handout provided to attendees entitled “The Foundation for Innovation and Action”.

Mike

Engaging health IT vendors

Although my viewpoint is probably somewhat biased given my day job with a heath IT vendor, I hold the firm conviction that the health IT vendors have an important and valuable role to play in helping shape local, regional, provincial, and national health IT plans.   The extent to which organizations across Canada consult with vendors outside the formal procurement process varies considerably, though I am noting a gradual trend towards more meaningful engagement.

A number of healthcare IT organizations including Canada Health Infoway, Manitoba eHealth, and the Chief Health Information Officer’s office at the  Nova Scotia Department of Health, for example, hold periodic briefing sessions.   In addition, ITAC Health works with organizations such as eHealth Ontario to organize vendor information sessions.

As I have mentioned in previous blog posts, one of the more innovative organizations with respect to vendor engagement is the South West LHIN.  Shortly after joining the organization, Glenn Lanteigne, the LHIN CIO, instituted what he calls “Vendor Fridays”.  These 2 to 3 hour sessions provide an opportunity for vendors to offer insight into how their products and services can help the LHIN achieve its strategic objectives.  Equally important, these sessions provide a forum for vendors to chat with LHIN IT staff and interested provider stakeholders about their needs.

Not content with the information flow that “Vendor Fridays” has engendered, the South West LHIN recently invited vendors to participate in a “Consumer eHealth Innovation Day”.   This “public – private sector” workshop is the first of five workshops designed, in Glenn’s words, to “address real-life LHIN issues and explore how these types of solutions can help and how“.   Other topic areas that will be addressed in future workshops align with the LHIN eHealth strategy.  These areas include Capacity Management, Decision Support, Quality, and the Electronic Health Record.

The Consumer eHealth Innovation workshop will take place on Thursday, June 30th, at the University of Western Ontario’s Research Park Convention Centre.  You can find more details here or by calling 519-640-2592 or emailing Jordan.lange@LHINS.ON.CA.

What do you think of the South West LHIN’s efforts to meaningful engage health IT vendors?  Do you have any suggestions for how healthcare organizations can meaningfully engage health IT vendors?

Mike

 

eHealth Ontario is read the riot act

Not sure where I stand on this issue. The current management of the agency continues to pay for the sins of the past. Doesn’t seem terribly fair, but this is all about political perception.

Mark