Tag Archives: eHealth Ontario

“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.




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.



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”.


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?



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.


In Conversation with Greg Reed

I met this week with Greg Reed, CEO at eHealth Ontario.   As he nears his first anniversary in the CEO role, Mr. Reed reflected briefly on progress to date dealing with the Auditor General’s concerns and spent considerable time explaining how the agency will lead the “development of interoperable electronic health records across all classes of providers using regional hubs that correspond to natural referral areas”.   Mr. Reed shared that he has and continues to spend much of his time working with stakeholders across the continuum of care to ensure that they are meaningfully engaged in the process of defining what will be achieved and how it will be accomplished. While much of this work remains largely unseen by many people, Mr. Reed believes that it is an absolutely critical step in executing a cohesive plan for accelerating adoption and effective use of IT in the Ontario health sector.

Like others with whom I have spoken in the past few months, I am frustrated at times with what appears to be the relatively slow pace at which eHealth Ontario appears to be moving.  Yet, when I chat with Mr. Reed, I am reminded of the enormous challenge he faces in trying to meaningfully engage a diverse set of stakeholders. Unlike large US healthcare organizations such as Kaiser Permanente or the Veterans Administration that are often cited as model users of health IT, the Ontario health sector is not managed as a single organization.  Rather, it is a complex ecosystem of relatively independent organizations that range in size from solo medical practices to very large hospitals.  While mandating a specific direction may at times be tempting, previous attempts to do so proved disastrous and Mr. Reed has opted instead to employ a more consultative approach.

Is Mr. Reed’s approach the way to go?  Consultation takes time and many people feel that the time for talking has passed.   Though I often share this point of view, my periodic conversations with Mr. Reed leave me wondering whether patience and a willingness to engage all stakeholders  may actually achieve better results in the long term than iron-fisted dictate.  Listening to Mr. Reed speak, I cannot help but feel that he has a clearly well thought out plan for getting the various stakeholders moving in the same direction, a direction that they have collaboratively developed and in which they mutually agree to head.   Maybe it is time that Mr. Reed publicly offers more insight into his activities and philosophies.  Many people may still not agree with his approach but at least they will be assured that he does in fact have one.



Infoway launches blog

With little fanfare, Canada Health Infoway recently put a toe in the social media waters with the launch of its new blog; check it out by clicking the “blog” link on the Infoway home page (www.infoway.ca).

I have been making the case (some say I am “advocating while others are suggesting that I nagging or even badgering) for increased use of social media by organizations such as Infoway and eHealth Ontario for the better part of the past year.  As it turns out, these organizations are proceeding slowly and cautiously.  Given the pitfalls and dangers that accompany the many benefits of using social media, their methodical approach to implementing social media is understandable.

I encourage you to read and contribute to the Infoway blog; I have already posted several comments.  Social media works best when there is an active conversation and I know that the people responsible for social media at Infoway truly want to create an active dialog with as wide a group of stakeholders as possible. So, here is your chance to put them to the test!


eHealth’s Greg Reed at OHA eHealthAchieve

Greg Reed, eHealth Ontario’s newish CEO, opened the 2nd day of the joint Ontario Hospital Association / COACH eHealthAchieve conference in Toronto. This event marked the second time in just under a month that I had an opportunity to listen to Mr. Reed give an update on eHealth Ontario and I will confess that I did not expect to learn anything new from Mr. Reed’s latest presentation. For the most part, my expectations were met. Much of what Mr. Reed had to say can be found in my 13 October 2010 blog post about his presentation at an ITAC vendor forum. However, while Mr. Reed’s talk did not differ substantially in substance, it offered a considerably evolved articulation of eHealth Ontario’s role as well as further glimpses into eHealth Ontario’s as yet to be revealed strategic plan.

According to Mr. Reed, eHealth Ontario will lead by serving Ontario’s healthcare providers (what Mr. Reed calls as “servant leader” approach. In this role, eHealth Ontario will:

  • Leverage provider insight, investments to date, and best practices
  • Accelerate progress on local and regional eHealth initiatives
  • Normalize local and regional initiatives through standards, best practices, and architecture
  • Coordinate the activities of providers to minimize duplication and promote replication and reuse
  • Deliver core infrastructure and provincial systems that benefit multiple providers and whose cost is greater than any one provider can justify

Mr. Reed explained that eHealth Ontario will fund local and regional projects as well as deliver core infrastructure and provincial systems. These investments will be made in projects that:

  • Contribute to the overall convergence towards a provincial electronic health record for all Ontarians
  • Result in systems that are interoperable with other local, regional, and provincial systems
  • Adhere to provincial standards and practices
  • Move as much patient information as possible to front line care providers

Brand new at this event was a commitment to some form of personal health record. Mr. Reed stated that eHealth Ontario would have in place, by early 2013, a standard for packaging and sharing an individual’s personal health information and that he expected at least pilot implementations to follow not long after. Mr. Reed also amended his previous articulation of eHealth’s overarching goal to include the subject of care as well as the person delivering the care. This enhanced focus on the patient perspective for eHealth was further reinforced in a video produced by eHealth Ontario (shared by Mr. Reed during the presentation) that offers patient as well as provider and health IT professional perspectives on electronic health records.

It is clear that eHealth Ontario’s articulation of who they are and what role they play is becoming crisper and more concise. Details regarding a revised strategic plan are still unclear and no timetable as to when this plan might be released were offered.


P.S.  Following my initial post, eHealth Ontario contacted me to clarify Greg’s remarks regarding PHR deployment.  eHealth Ontario believes that if prototype PHR applications can be developed at the same regional integration hubs are deployed, than PHR pilots may be available in some part of the province as early as 2013.


Ontario Leading the Way with EMRs? Really?

According to an article posted on the CTV Toronto website, Health Minister Deb Matthews is quoted as saying:

“We’ve got more physicians with electronic medical records than any other province in the country. We are now a leader when it comes to the adoption of it.”

Hang on just a sec, Minister Matthews.  I am huge proponent of the value of EMRs in physician offices and I think that there is a critical role for eHealth Ontario to play in driving use of IT in healthcare.  HOWEVER … I think that it is disingenuous to say that Ontario is a leader just because nearly 5,500 doctors have installed an EMR.

To start, according to Canadian Medical Association statistics, only three provinces (QC, QB, and BC) have more than 5,500 doctors and only one province (QC) has more than 5,500 family physicians (the type of physician typically targeted for an EMR).  So, the claim that Ontario has more doctors that have adopted an EMR than any other province is a rather hallow victory.  What would be more useful is a comparison expressed in terms of a percentage of the doctors in each province.   I highly suspect when viewed in this light that Ontario is not the leading province in terms of EMR adoption.

Another important distinction is “adoption” vs “use”.  Just because a physician has installed an EMR doesn’t mean that they are making “meaningful use”.  A 2009 Commonwealth Fund study showed that both Canada and the US lagged most other industrialized countries in using many of the EMR functions that offer significant clinical benefits.  It would be interesting to know the extent to which the 5,500 doctors who have an installed an EMR are making “meaningful use” of this technology.

As I said earlier in this blog post, I think that Ontario is on the right track with its program to drive EMR adoption and use.  Further, I believe that OntarioMD, the group set up within the Ontario Medical Association to implement Ontario’s EMR program, is making good progress and has many good initiatives in place.  I just don’t believe that we should ignore or gloss over the facts in pursuit of a good news story.


Local Integration Activities – Hamilton Niagara Haldimand Brant LHIN

The CMA’s recently released 5-year Health IT strategy (see my blog post for more details) advocates, among other things, more local and regional integration projects to facilitate the exchange of patient information among providers within local referral areas.   A good example of regional integration was recently highlighted in an article in the Hamilton Spectator. According to the Spectator article:

“All electronic hospital records within the Local Health Integration Network can be accessed interhospital, except for Brant Community Healthcare and Grimsby’s West Lincoln. The accessible records for approved persons include hospital visits, treatments and procedures, tests and hospital lab results according to HHS [Hamilton Health Science] officials. Access to individual doctors’ records will come in an unspecified future phase.”

The article offers several quotes from eHealth Ontario’s CEO Greg Reed, including one of the first succinct statements on the role of eHealth Ontario.  According to Mr. Reed,  “EHealth’s role is to develop common standards to make them connected, and to form central registries of such information as inoculations given.

Mr. Reed also notes that “Ontario’s Local Health Integration Networks are grouped into five regional areas with their own electronic patient record-sharing system” He suggests that people think of eHealth as a “network of networks” and observes that “The job is not to build electronic records but to expand and connect existing ones – so a family doctor for example, can view radiology and lab results to become better informed about their patients.”