What is Best for the Patient?

First published in Healthcare Information and Communications Canada:

A little over two years ago I took a left hand turn in my career path when I joined a regional EHR program as their Project Manager. Having written and spoken about interoperability and digital health solutions, I wanted to “put my money where my mouth is” so to speak and devote my time and talent to realizing the vision that I so often advocated.

I am fortunate to be working with a dedicated group of people committed to making a difference for patients in Ontario. Whenever we are faced with a di cult situation or are choosing from what appear to be similar options, at least one member of the team always asks, “What is best for the patient?”

My wife is one of these patients.

Diagnosed about ten years ago with a chronic illness, Tracy recently embarked on a new journey to speak for those whose voices are not quite loud enough and to provide perspective to those who want to listen.

A talented writer, Tracy uses her blog to share her own experiences engaging the health system, offers insights on the view from the other end of the stethoscope (or, of interest to readers of this magazine, healthcare apps) and, from time to time, advocates for change.

Tracy has discovered, to her dismay, what others such as the McMaster Health Forum have observed: the patient is often not at the centre of care.

In a brief prepared to stimulate discussions by a citizen panel on strengthening care for people with chronic diseases in Ontario, the McMaster Health Forum notes:

“Health professionals don’t always work together to get people the care they need, despite this being important for improving patients’ outcomes.”

A briefing note prepared by the Institute for Clinical Evaluative Sciences (ICES) on variations in quality indicators across Ontario physician networks offers a similar perspective:

“Patients living with chronic disease have the best outcomes when they are treated throughout the progression of their disease, in a coordinated manner that engages all medical professionals involved in their care. However, in Ontario there has been a history of fragmentation of chronic disease care, leading to serious gaps.”

According to the McMaster Health Forum brief, access to their own health information can “help patients set goals for their health, manage their own care and better engage in decisions about their care with their providers.”

Unfortunately, the same brief also notes that there is “a lack of electronic health records that put all of a patient’s health information in one place” and, as a result, “patients also do not typically have access to their health information.”

As Internet pioneers and founding executives of several Internet start-ups (different companies before we met), Tracy and I both witnessed the creativity and innovation that was unleashed when entrepreneurs were given access to a platform (in this case, the Internet) on which to construct new applications and services

The banks recognize this same potential and are creating similar environments

to encourage innovation in financial services. Scotia Bank, for example, created the Digital Factory which they describe as a “hub for creation and incubation of new and partner-led ideas to deliver game-changing solutions for Scotiabank customers.”

Can the health system take a similar approach to encourage the development of applications and services to manage their own care and more e ectively engage their healthcare providers? Mohawk College and eHealth Ontario think so. They have partnered to create the eHealth Ontario Innovation Lab, an online, open provincial EHR platform that allows testing of digital health solutions in a virtual EHR environment.

Operationally and physically isolated from eHealth Ontario’s production environments, the Innovation Lab’s Virtual Lab Environment contains copies of eHealth Ontario EHR test environment assets and a fabricated, integrated EHR data set. These assets currently include the Ontario provincial client registry and the Ontario Lab Information System (OLIS), with the Ontario provider registry soon to be available.

Whether the eHealth Ontario Innovation Lab generates new and useful digital health solutions remains to be seen. At the very least, it provides developers with access to the provincial systems in which patient information is stored, information that patients can use to manage their own care and more effectively engage healthcare providers.

I recently shared Tracy’s blog with a friend of mine. He commented, with a wry smile, that we must have very interesting dinnertime conversations. We do. She inspires me each and every day to do what is best for the patient.

You can at themadnessmaven.ca

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COACH / HIMSS Ontario Update 2015

For the second year in a row COACH and HIMSS Ontario are hosting Ontario Update, a one day conference at which key public sector leaders share their insights and offer updates on local, regional and provincial eHealth initiatives.

Speakers at Ontario Update 2015  include Michael Green from Canada Health Infoway, Sarah Hutchison from OntarioMD, Peter Bascom from eHealth Ontario and Dr. Ed Brown from OTN.     The day will include a panel discussion on the current status of the various “connecting” projects: cGTA, cSWO, and cNEO.

I have been a member of the organizing committee for this conference since its inception.  Last year we sold out and had a waiting list of people who wanted to attend.   There are still tickets available for this year but, given the opportunity to connect with public sector leader, these tickets will go quickly.

You can find more details at:

http://www.coachorg.com/en/newsandevents/ONUP-2015-Speakers—Agenda.asp

You can register at: https://ams.coachorg.com/events/list.aspx

I am looking forward to this opportunity to meet with the health IT leaders whose work I track and write about.  I hope to see you there!

Mike

New eHealth Ontario CEO

According to a media release from the Premier’s office, Cynthia Morton has been appointed as the new eHealth Ontario CEO, effectively immediately. Previously, Ms. Morton was a Deputy Minister with the Ontario Ministry of Labour.

David Hallett, currently Associate Deputy Minister of the Ministry of Health and Long-Term Care and eHealth Ontario board member, takes on a new role as Associate Deputy Minister, Pan Am and Parapan Am Games effective September 2, 2014.

Mike

Tugging on Superman’s Cape – Contrarian Views Applied to the Digital Health Agenda

I have teamed with my friend and mentor, William Pascal,  to write a series of articles challenging conventional wisdoms about the Canadian digital health agenda.  Here is the first article in the series which sets the stage for the remainder of the articles

“Time spent arguing is, oddly enough, almost never wasted.” ―Christopher Hitchens, Letters to a Young Contrarian

Introduction

What if we do not need new funding for the digital agenda in Canada? What if we no longer need a Canada Health Infoway or similar bodies such as eHealth Ontario? What if we are less concerned about privacy and more concerned about delivering better care? What if the private sector manages all back office operations for the health sector? All these statements are contrary to conventional wisdom, but are they wrong?

What is conventional wisdom? It can be defined as ideas so accepted they go unquestioned. Think about the Wright brothers. If they had listened to conventional wisdom, they would never have even tried to build a flying machine and our world would be a very different place. Think about the impact on society today if Alexander Graham Bell had been discouraged and gave up when he was told that his invention of the telephone had no inherent value by Western Union.

Too often we accept what’s conventional thinking without trying to see what’s possible and available. The real problem with using conventional wisdom as a guide is that we will constantly be behind the curve, safe with the general masses but missing the opportunities to think independently and create something new or change an existing way of thinking. Ten years ago, who would have thought we’d be spending more money renting software than purchasing it?. Fifteen years ago, mobile devices were not viewed as a key enabler of care when we created an eHealth strategy for Canada.

New ideas or ways to address difficult issues almost always challenges conventional wisdom. Inspired by this reality, we have embarked on a quest to challenge, through a series of articles, some of the conventional wisdom that we believe underlies the approaches to the public policy thinking that is driving the digital agenda in Canada.

This paper, the first in our series of articles challenging Canadian digital health conventional wisdoms, provides a high level overview of the challenges facing the health care system, a description of the digital agenda in the healthcare sector, the status of this agenda in Canada, some observations on this journey, lessons to be drawn from experiences in Canada and Internationally and a suggested list of contrarian possibilities that draw into question conventional wisdom. Subsequent articles will explore these suggested different future states.

You can read the remainder of this paper here.

Mike

 

 

Musings on the next eHealth Ontario CEO

Earlier this year Greg Reed, eHealth Ontario’s CEO, announced that he was resigning his position effective October 2013. Although there was a flurry of media attention when the resignation was announced, mainly focused on Mr. Reed’s severance package, there has been little speculation since then regarding Mr. Reed’s possible successor. Who are the possible candidates for this role?

See the remainder of my Technology for Doctors article here

Mike

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.