Guest Blog – South West LHIN Consumer eHealth Innovation Session

Richard Booth is a nurse and PhD candidate with a strong interest in the use of information in the delivery of healthcare services.  Richard has a particular interest in social media and is doing what he can to educate fellow clinicians on the power of social media.

Richard and I both attended the recent Consumer eHealth Innovation Session hosted by the SouthWest LHIN.  We both actively tweeted from the event and I asked Richard if he would write down this thoughts for a guest blog post.  The remainder of this post contains Richard’s observations on the event.

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On June 30th, 2011, I had the opportunity to attend the South West LHIN’s “Consumer eHealth Innovation Session” held at The University of Western Ontario. As described in Michael’s previous blog post, the event was billed to provide a venue for attendees to see how various eHealth tools were being used to support the LHIN’s eHealth strategic plan. On the agenda were a number of companies and organizations working with the SWLHIN, including Telus, Microsoft, thehealthline, Sensory Technologies, Sykes, Patientway, OTN, and CareLink.

Unfortunately, I was not able to arrive to the session until around 10:00am which meant I missed the introduction by Glenn and presentations given by both Telus and Microsoft. I’ll touch upon some of the points from each presentation I attended and outline what I thought to be salient:

• thehealthline.ca was presented by Brian Ashby. This online portal to health information in the SWLHIN looks to be a fantastic resource – similarly, the document “Help yourself through hard times” is a booklet that organizes all the key community and social resources that may be required by individuals and their families during “hard times”. What I think makes this document invaluable is that each organization/agency listed in the booklet has a descriptor of the services offered and hours of operation. This document is freely available on the thehealthline.ca website.
• Sensory Technologies spoke about their eShift 2.0 model for homecare. In a nutshell, in an eShift delivery model, nurses work remotely and act as a delegator and knowledge broker of healthcare. Personal Support Workers (PSWs) with extra training deliver the health services to the client, in the client’s home. The PSWs and nurses are connected by way of an iPhone, and if the nurse deems further care is required, a higher skilled assessment can be authorized and delivered to the client. I believe my tweet related to this presentation summarized my feelings regarding this care delivery shift: “eShift 2.0 is a delivery model I need to examine more closely. Like it or not, this typology of care delivery is the future #swlhin.” I will be curious to see how regulators like the College of Nurses of Ontario respond to the remote monitoring of patients by nurses and unregulated healthcare providers, like that outlined in the eShift 2.0 model.
• Sykes presented next, introducing a self-management care model – CareCoach and teletriage. The presenters also listed various other services offered by Sykes, including chronic disease management, tobacco cessation services, and health education services.
• PatientWay had an engaging presentation outlining their kiosk and way finding solutions that are currently used in a number of healthcare organizations around Ontario. Their concise and succinct presentation outlined how the use of their systems had significantly reduced costs for organizations, and at times, facilitated an increase in engagement by consumers. Jay from PatientWay described to me that by engaging consumers in a meaningful and productive fashion during their healthcare interaction(s), you can sometimes reduce the anxiety and stress of the situation. I guess the old mantra of ‘an active mind is a healthy one’ rings true in this instance. By engaging consumers during their various ‘wait times’ (i.e., waiting for registration or information taking), you can potentially increase efficiency and engagement consumer in the health process.
• Laurie from Ontario Telemedicine Network (OTN) presented next, outlining the results of their pilot research examining the effectiveness of remote monitoring technologies to support the healthcare of consumers suffering from chronic illness at home. Nurses at a family health team would remotely ‘check’ the results of their assigned clients in the community and decisions regarding care were made appropriately. At the end of the four month study, Laurie stated that many of the clients wanted to keep the remote monitoring technology as they had found value in its use. Yet again, another call to engage consumers in a meaningful fashion and move away from purely paternalistic approaches of health delivery.
• Finally, CareLink provided an interesting presentation on their suite of remote monitoring technology. The range of monitoring technologies offered by CareLink to ‘wire’ a house was extremely impressive. If/Than programming could be directly fed into the smart house to enable prompts to be pushed to caregivers in the circle of care (e.g., if Grandma doesn’t open the fridge and/or her pill bottles by 0900, a message is sent to caregivers prompting of the situation). Video cameras and other sorts of surveillance systems were also offered by CareLink as a means of being able to view in real time, a loved one living at home. In other words, CareLink modifies the current suite of home security technology for use within a health/individual monitoring context. What was not touched upon in the presentation were the potential ethical and privacy issues related to this type of invasive surveillance. Although I can see the functionality of this technology for some cognitively compromised populations, it does raise some important issues regarding autonomy and dignity.

The Innovative Ideas Workshop occurred after lunch – we were tasked with answering three brief questions related to how the technologies/ideas presented over the morning could be used to assist healthcare of individuals. The 30 minute task led to some interesting (and at times divided) discussions in the small breakout groups. This eventually fed into a large group feedback session led by Glenn who asked all groups to report their findings. In sum, these were the salient ideas I captured and tweeted during the discussion:

• LTC patients, and repatriating to the home is ‘doable’, but should be looked at closer as it is currently a difficult and cumbersome process
• We need to examine the 5 percent of the population who are the highest users of the health system. Engage and utilize eHealth in these areas appropriately improve care and reduce inefficiency.
• Need to refocus on the consumer; vendors need to work together to achieve this.
• Homecare is “imminently important”
• Business drivers from healthcare are currently missing – we need to use the data that the government currently has to help build a better business case
• Accountability – need more discussion on this topic, from all angles, including patients, clinicians, consumers, vendors, government, etc.

Upon closing, Glenn stated that he hopes to hold another event in six months time. The unfortunate lack of tweeting from the event was a bit of a surprise – the smartphone penetration in the room was 100% (we did a show of hands). At future events, I hope participants utilize twitter in a bit more functional and consistent manner. Similarly, I believe future events would benefit from having ‘consumer groups’ in attendance. There were a number of specific consumer groups mentioned and highlighted during the workshop (e.g., homecare, ALS, diabetes, mental health, long-term care, etc.). It would be interesting (and probably dynamic) to have these stakeholder groups present during the presentations and discussion. Finally, I was disappointed at the number of clinicians in attendance. At one point during the morning, a show of hands was requested for “practicing clinicians”. I counted only five or six out of the audience of well over 50. Although the reasons for the lack of clinician attendance is probably extremely multidimensional (e.g., workload, scheduling, potential lack of interest, etc.), it does warrant further reflection.

Overall, I was extremely impressed with the workshop. This was the first event that I’ve been to with eHealth vendors which felt collaborative, rather than competitive. Equally, it was one of the few instances where talk of ‘technology’ generally took a backseat to the ‘client’ and ‘health’. Normally at eHealth events, the discussion is extremely techno-medical-centric. This Consumer eHealth Innovation Session was a breath of fresh-air.

Richard Booth, RN, MScN

Microsoft Healthvault Not Profitable in the US

An article earlier this week in the Financial Times states that “Microsoft has abandoned efforts to make profits in the US out of its Healthvault cloud computing system“.  Citing “complexity in the country’s health system“, Peter Neupert, corporate vice-president for health, says that the primary benefit to continued operation of Healthvault in the US is to “increase the brand relationship“.   Not only will Microsoft not charge US users  to use Healthvault, the company also committed to not attempt to generate revenue from advertising or other sources.

Microsoft is apparently still pursuing revenue generation opportunities in other countries in which Healthvault operates including Canada. Given Canada’s federated health system, with each province pursuing different priorities and approaches, will Microsoft and its Canadian partner, Telus, experience similar difficulties in achieving profitability?

Mike

An important step towards more open healthcare IT systems

For years one of the major complaints about healthcare IT systems has been the closed and proprietary nature of most vendor offerings.  As we move to improve “information liquidity” (a cool term I read about it a Deloitte study, I believe) across the continuum of care. announcements such as the following are most welcome:

http://www.prnewswire.com/news-releases/eclipsys-and-microsoft-form-strategic-alliance-to-make-enterprise-health-it-more-open-and-powerful-85193517.html

Of particular note in the press release is the statement:

The Microsoft agreement is part of Eclipsys’ open platform initiative, by which Eclipsys plans to expand its reach by working collaboratively with other industry participants to enhance interoperability, and enabling third parties to develop new applications that work natively with Eclipsys solutions.

I added the bold to emphasize Eclipsys’ intent to support third party applications.  Taking a page from Internet pioneers and giants Amazon, Facebook, and Google, Eclipsys is creating the conditions for an ecosystem in which they do not try to be all things to their customer.  By allowing third parties to add value to their core platform they will make this platform more valuable and more attractive to current and prospective customers.

I hope that other vendors, particularly Canadian EMR vendors, take note of the Eclipsys strategy.  Opening up your platform so that other vendors can develop applications that make use of the information stored in your systems is good for the customer, good for our health system, and good for your bottom line.

Microsoft and Consumer eHealth

I have written many times in the past (on this blog and through other channels) on the potential of Microsoft to play a key role in consumer eHealth.  In addition to Microsoft HealthVault, the company has released information about other ideas currently in their labs:

http://www.pcworld.com/businesscenter/article/188848/microsoft_ehealth_research_taps_xbox_mobile_phones.html

Ideas include:

• smartphone apps that use sensors such accelerometers, camera, and microphone to help people keep daily logs of their activities.  I am considering employing a personal trainer to get into better shape and they have suggested that keeping such a log is an important part of a wellness and fitness program.
• Use of xbox 360 platform in hospital rooms to “to feed information from electronic medical records onto in-room display screens for patients”
• Computers built into tabletops that would instruct patients on how to care for themselves when outsidemthe hospital. “The computers could be used to pull content like X-ray images from personal records, or other pictures from the Internet, and to save them for the patient to view later.”

While some of these ideas might seem far fetched, I find it interesting to watch how a large consumer electronics and software company like Microsoft is exploring health applications for their products.

Mike

Healthvault lands in Germany

A little more than a year ago I attended Microsoft session on Healthvault and asked about their business model; ie, how did they plan to make money?  Part of the answer involved licensing deals in countries with publicly funded healthcare systems.  While we have seen the first non-US implementation in Canada, it is not yet clear when we will see a provincial gov’t step to paying for healthvaults for its citizens.   Just recently, Microsoft has announced a partnership with Siemens to roll out Healthvault in Germany

http://www.healthcareitnews.com/news/siemens-license-healthvault-german-market

The article was light on details about revenue generation.  However, I think that this news shows that there is still strong interest in Healthvault and we will yet see large scale deployments that somehow support electronic exchange of data with publicly funded eHealth systems.

Mike

Ballmer – Focus on the patient

Steve Ballmer, Microsoft CEO, recently advised tech companies in Nashville TN:

“Start the dialogue with the physician with the patient’s perspective and the patient’s information in mind. It may not be the most rewarding in the short-term, but it’s the most transformational thing you’ll be able to do in the long run”

http://www.fiercehealthit.com/story/microsofts-ballmer-focus-patient-long-term-gains/2010-01-25?utm_medium=nl&utm_source=internal#ixzz0dej3UuNP

Mike

The Winds of Change

There is a growing debate emerging in many countries about the value of regional and national electronic health record systems, most of which are still in the development stage.  Recently, high profile criticism has emerged suggesting that national EHR initiatives in the US and the UK are going in the wrong direction.

In the US (http://www.nextgov.com/nextgov/ng_20090806_7349.php?oref=topstory) Eric Schmidt, Google CEO and member of the President’s Council on Science and Technology (PCAST) stated during a PCAST sessions that “the national health IT system should be based on Web records that patients can control”.  When David Blumenthal, national coordinator for health information technology, suggested that his office is working on plans that will allow certain kinds of communications with personal health records, Schmidt responded that “Giving me a summary … is not the same thing as giving me the record.”

During the same meeting, Craig Mundie, Microsoft’s chieft research and strategy officer said that “the administration also should focus more on how to manage medical data — including metadata to locate key pieces of information quickly — rather than on the specifics of the electronic health records”.  Richard Levin, president of Yale University, pointed out the current electronic health record systems are proprietary and don’t interoperate.  He stated “What is out there is not very good” and that “the reality is dismal”.

In the UK, a similar attack on their current eHealth architecture is raging.  The opposition Conservative party is proposing use of personal health record services such as those offered by Google and Microsoft in place of the current architecture deployed by the NHS National Programme for IT.

http://www.e-health-insider.com/news/5107/conservatives_to_%E2%80%98dismantle%E2%80%99_nhs_it

The Conservatives state that, if elected they would  “stop imposing central IT systems on the NHS” and instead “allow healthcare providers to use and develop the IT they have already purchased and developed, within a rigorous framework of interoperability”.  The Conservatives propose that “Patient records should be stored locally rather than on a national database, with the capability of transferring the information when necessary”.

What elements of these two debates are relative to Canada?

Mike

US and UK suggestions re: PHR vs. legacy EMR/EHR

TELUS Health Space, powered by Microsoft HealthVault

I was reading a very recent press release from TELUS and their latest move (with MSFT) into the consumer eHealth market. What I found interesting from the article is that “TELUS is granted the exclusive license to host and operate the Healthvault platform for the development of a consumer-focused e-health service in Canada“. The article then goes on to explain that Canadians will be able to manage and store personal health info, and offer access to applications such as:

• personal health record
• chronic disease management
• pediatric care
• wellness products

Not surprisingly it appears that MSFT will provide the technology and the branded TELUS Health Space will act as the operator and securely host the infrastructure and health data. The service is going to be made available to the government and healthcare providers, who will then be encouraged to offer this to patients.

A very interesting model. What does anyone think? Is this a good thing for the consumer and all the other stakeholders involved?

Mark

Do People Want to Share Personal Health Information?

In the summer of 2007 I interviewed a cancer patient who was using Grand River’s oncology portal (My CARE Source) for an article in Healthcare Information and Communications Canada magazine.  My goal was to get a users view of the value of this service.  Having survived Hodgkin’s disease as a teenager, the person who I interviewed was able to compare what it was like to battle cancer with and without the help of a computer-based tool.  I was reminded of this interview when I read the following blog post about a new feature of Google Health that facilitates the sharing of personal health information:

http://www.thehealthcareblog.com/the_health_care_blog/2009/03/google-health-sharing–simple-but-potentially-important.html

Although the person I interviewed did not use the phrase “Personal Health Record” (PHR) during our conversation, she did offer a perspective echoed by many PHR supporters.  She emphatically stated several times during our conversation that she felt very strongly that “they [her medical records] are my records and I feel that I should be able to have immediate access to them when I want.”  Further, she asserted that she should be able to offer access to these records to whoever might be involved in any aspect of her care.  

The blog post to which I refer above suggests that “the big next phase is people offering to share these records with their physicians. We’ll see but this may well be the killer app the PHR has been looking for—after all now a doctor just needs one Google sign-in which they almost certainly have anyway, and they can see all the Google Health PHRs of the patients who start sharing their records with them. And they will. This has the potential to be really disruptive.”  What do you think of this perspective?  Do you think that we will see physicians and patients electronically sharing health information?

Practical Use of Microsoft Healthvault

I have written and spoken about Microsoft’s Healthvault service a number of times in the past few years.  For those who haven’t heard of it, Healthvault is a personal health and medical information repository that is controlled by each individual, not a healthcare provider organization such as a hospital.  Individuals specify who can access their Healthvault and can use it to quickly and easily share personal health information with whomever they choose.

One of the most significant decisions made by Microsoft in Healthvault’s design is that it is  Perhaps the most significant reason is that it is a service, not an application. Rather than build their own health and wellness applications, Microsoft is encouraging others to do so. The result will be a rich and diverse collection of health and wellness applications all using Healthvault to store personal health information.

A recently announced example of how Healthvault can be used is the new the Hawaii Medical Services Association (HMSA), an independent licensee of the Blue Cross and Blue Shield Assoction which provides health insurance to more than half of Hawaii’s residents. This service connects individuals seeking medical care with participating physicians either by phone or online using Web-based videoconferencing or secure chat. The service is highly interactive, with individuals able to have a real-time conversation with a physician and uses Microsoft’s Healthvault as one mechanism for sharing health and medical information with the physician.

According to HMSA, “Online consultations are not meant to replace in-person doctor visits; they simply provide another health care choice for talking to a doctor about a non-urgent condition or getting advice or answers.” In addition to providing advice about non-urgent conditions, physicians can also refill prescriptions, discuss medication discussions, or explain generic drugs.

What do you think of the Online Care service? It is a model that could work in Canada? Do you think that online delivery of specific healthcare services is a viable model?  What about Microsof’t Healthvault?  Will people be prepared to store their information on-line using applications such  as Online Care?