Tag Archives: Greg Reed

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

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

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

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.

Mike

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.

Mike

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.”

Mike

Greg Reed at ITAC Vendor Forum

Today I attended an ITAC Health vendor information session at which Greg Reed, the CEO of eHealth Ontario, provided an update on the agency’s plans and priorities.  While I had hoped that Mr. Reed would make a more definitive statement regarding the agency’s role and offer a clear articulation of the agency’s updated strategic plan, I did walk away with a better sense of the underlying philosophies influencing how the agency operates and the challenges that it faces in positioning itself in the complex Ontario health system.

Mr. Reed continues to demonstrate an unwavering commitment to “getting it right” and steadfastly refuses to assert his own views about the “right” direction for either the agency or eHealth in Ontario.  Instead, Mr. Reed insists that he needs to take the time necessary to consult with all stakeholders.

Mr. Reed spoke for just under an hour and then took questions.  He divided his presentations into four parts to cover the following topics:

  • Update on various efforts to remediate eHealth Ontario
  • Observations on what he has seen / heard during his visits across the province
  • Update on strategic planning activities
  • Musings on eHealth Ontario’s role

Mr. Reed structured his remarks on efforts to remediate problems at eHealth Ontario in terms of the four general areas of concern raised in the Auditor General’s report.  He noted that the agency’s analysis identified 84 root causes for the problems identified by the Auditor General. In terns of the four areas of concern, Mr. Reed offered the following update on efforts to address these concerns:

  • Oversight / governance – The agency is “almost there” in addressing these concerns according to Mr. Reed.
  • Procurement – The agency has overhauled the procurement process so that it is more open and transparent albeit more complicated.  According to Mr.  Reed, the agency is “just about done” addressing this area of concern.
  • Project planning – The agency needs “outside help” and has engaged someone (wasn’t clear whether it was new hire or a consulting engagement) to lead remediation efforts in this area.  Mr.  Reed stated that he could not identify the person but that an announcement was forthcoming in the near future.
  • Strategic planning – Mr. Reed had “hoped to have a plan by now” but that he was still talking to stakeholders to get feedback.  As part of this process Mr. Reed indicated that he wanted to engage the audience is a dialog during the question and answer portion of his presentation.

Mr. Reed offered additional insights regarding remediation efforts including:

  • The eHelath Ontario leadership team has been “reinforced” with “8 or 9 new vice-presidents
  • Significant staffing changes.  150 out of a total staff complement of “800 to 850” employees have left the agency and roughly 200 new employees have been hired.  Some of the new hires replace consultants.   According to Mr. Reed, there are now 118 consultants working at the agency.  This number represents about 12% of the eHealth Ontario workforce, a level that Mr. Reed feels is “about right”.
  • Joint planning with Ontario government regarding network and data centre operations. The Ontario government is reusing portions of the eHealth Ontario network for other gov’t department traffic and there are discussions regarding use of an existing Ontario government data centre.
  • Working to change the organization’s culture from “command and control” to “more open and transparent” where good ideas can come from anywhere, not just through the chain of command.

Mr. Reed explained that he had spent considerable time “in the field” talking to an “alphabet soup” of organizations. He noted that it quickly became apparent to him that the Ontario health sector was a complex environment which he categorized as “very heterogeneous” in many ways, from process to technology. This complexity will, according to Mr. Reed, make developing an interoperable electronic health record a “daunting task”.

When engaging various stakeholders, Mr. Reed explained that his approach has been “listen, learn, hypothesize ideas, and solicit feedback on these ideas”. It is this collaborative and iterative approach to developing a new strategic plan that is taking more time than expected but which is considered an important ingredient to arriving at the right strategy for Ontario.

There was a palpable change in the room when Mr. Reed shifted his presentation to an update on the strategic planning process. Many people reached for their notepads and could be seen scribbling furiously as Mr. Reed spoke. Mr. Reed opened his remarks regarding strategic planning by stating eHealth Ontario’s overarching goal: Whenever someone in Ontario touches the health system in the presence of a provider want that provider to have much information about the patient as possible, preferably in electronic form. Mr. Reed noted that keeping this information accurate and consistent while also assuring that it is securely protected is a major challenge given the high transaction rates that will have to be supported.

Mr. Reed talked at length about two strategic priorities:

  1. Deliver on key commitments. Mr. Reed stated that it was imperative that the agency deliver on commitments that it makes in order to build credibility. He offered a quick status report on several key initiatives including the Diabetes Registry (a misnomer, according to Mr. Reed, as it really is an application), Drug Information System (procurement expected to start late this year, early next year), and foundation technologies such as registries (client, provider, location, etc which need to be “cleaned up” and turned into a resource that the provider community can use).

    Mr. Reed mused about the difference between local initiatives and cross-sectoral projects such as Chronic Disease Management systems that “feel like government work”. These cross-sectoral applications have no economic incentive for a single provider but offer significant benefits to the health system as a whole. Such projects, according to Mr. Reed, are likely best handled at a provincial rather than local or regional level. Since many eHealth projects have more local benefits, Mr. Reed believes that many solutions will come from the provider community working with vendors.

  2. Drive meaningful use and adoption. According to Mr. Reed, the province is “awash in electronic health records” that range in sophistication and that have been designed to meet local needs. Most of these systems are not “controlled or owned by government”. The problem in driving an interoperable electronic health record is that these systems are not connected in any way and that we have, as a result, a plethora of “information silos”.

Mr. Reed introduced the concept of “natural referral areas” in which providers have an incentive to work together. According to Mr. Reed, there are 4 to 5 such areas in Ontario, most of which are larger than many provinces. Rather than a “big bang” approach that results in a single electronic health record system, Mr. Reed suggested that it makes more sense to develop an interoperable electronic health record within each referral area and link them at a later date. This multilateral approach respects local needs and priorities and potentially offers a way to get personal health records into patients’ hands sooner. By adhering to common standards and working towards a common goal, regional initiatives will eventually converge to create a provincial interoperable electronic health record while providing benefits at a faster pace than a unilateral, “big bang” approach.

To my disappointment, Mr. Reed did not offer a succinct and clear statement regarding eHealth Ontario’s role. Indeed, when asked during the question and answer session how the agency plans to work with the LHINs, Mr. Reed responded “I don’t know”. He did muse on the agency’s role, offering some thoughts, including:

  • Need to collaboratively develop an overall architectural framework, with the agency making the “hard decisions when necessary”.
  • Need to “draw people into the tent” rather than make pronouncements about how things should work.
  • The agency will act as a “strategic investor” funding local and regional projects around the province.
  • The leadership style is to be a “servant leader” that facilitates dialog and gets the right people in the room for this dialog

Overall, the presentation offered considerable insights into the philosophies and guiding principles but was a little short, I felt, on definitive statements of where to next and how we will get there. Perhaps Mr. Reed is right that more consultation is needed but I think that, at the very least, more definitive timelines as to when a new strategy will be in place and a succinct statement on the role of the agency are needed to set expectations and to drive discussions to a conclusion. What are your thoughts on what Mr. Reed shared today?

Mike