First impressions of Canada Health Infoway’s new CEO

Like many people in the Canadian Digital Health community, I was quite surprised this past June when the board of directors for Canada Health Infoway announced that they had selected Mr. Michael Green as their next President and Chief Executive Officer.

Uncharacteristically, I have had little to say on this appointment and have told anyone who asked that I had not yet formulated an opinion. After contemplating the matter and having had the opportunity to speak with Mr. Green, I am now ready to answer the question that so many readers have posed since the announcement in June: What do I think about Mr. Green’s appointment?

Read the rest of the article at Technology for Doctors.

Mike

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Infoway Response to Manitoba eHealth Story

Further to an earlier blog post regarding possible problems with eHealth projects in Manitoba, I’d like to point out a letter to the editor of the Winnipeg Free Press written by Richard Alvarez, CEO of Canada Health Infoway.  To spare you the task of digging through all the letters to the editor published that same day, I have extracted Mr. Alvarez’s letter:

E-health care

Re: Province’s eHealth push slow, costly (June 29). Your story presents a somewhat unbalanced perspective of what is happening in Manitoba. It inaccurately positions the enhancement and operations of the hospital information system within the Winnipeg Regional Health Authority as part of the province-wide deployment of the electronic health record (EHR) throughout Manitoba. They are, in fact, two separate initiatives.

Hospital information systems exist in almost all hospitals within Manitoba and have for many years. These systems continue to be expanded and enhanced, as is currently the case with the hospital systems within the Winnipeg Regional Health Authority.

The EHR being created for every resident is a separate initiative. A complete EHR contains six components: laboratory results, medication profiles, diagnostic images, clinical reports, patient and provider registries. Manitoba has already made significant progress towards this initiative.

For example, diagnostic images captured in hospitals, such as X-rays, are almost entirely digital throughout the province, allowing health providers to instantly share images with colleagues at the other end of the province. This helps reduce the need to transfer patients to larger centres. Components of two important registries are now in place and operating. Provider registries in place identify the authorized health professionals accessing and creating information in a patient’s EHR, and the client registries ensure each patient has a unique record. It is my understanding that complete patient laboratory and medication profiles will soon be available in a private and secure manner to authorized clinicians throughout the province.

This is an ambitious undertaking that will transform health care in Manitoba. While this effort requires a lot of work, resources, patience and time, its value is unquestionable. A better-informed health system will lead to increased patient safety, shorter wait times, and a host of efficiencies.

Richard C. Alvarez

Canada Health Infoway

eHealth 2010 – Blumenthal and Alvarez Share Their Views

One of the eHealth 2010 sessions that I looked forward to the most was a panel discussion with Dr. David Blumenthal, Director of the U.S. Office of the National Coordinator (ONC) for Health IT, and Mr. Richard Alvarez, President and CEO, Canada Health Infoway.   Both gentlemen have challenging mandates and there is no shortage of “monday morning quarterbacks” analyzing their every decision and parsing their every word.

Alan Gregg, noted pollster and social commentator, moderated the session.  For someone who professed to know very little about eHealth, he demonstrated an amazing grasp of the issues.  Citing his own research, Mr. Greg offered the following observations:

• Physicians view themselves as independent operators.
• Physicians don’t want bureaucrats dictating what they do.
• Left to their own devices physicians will do nothing to promote EMR/EHR.
• Not clear what eHealth offers a politician. Why should they support it?
• Not a “build it and they will come” proposition.  Need to get politicians, patients and physicians to buy-in first.
• eHealth is very much a communication and engagement issue.

Before taking questions from the audience, Mr. Gregg interviewed Dr. Blumenthal and Mr. Alvarez.  Some highlights of the conversation with Dr. Blumenthal included:

• “Meaningful use” is a powerful concept with which to measure progress. Dr. Blumenthal stated that “meaningful use” was one way to ensure that technology was making a difference.   He further elaborated that “meaningful use” starts with where we want to be with healthcare, not with what we want to do with technology.
• Biggest challenge will be creating interoperability.  Felt that adoption will happen in any event, if only because new physicians will bring it to the practice of medicine.
• US is employing a “carrot and stick” approach using financial incentives / penalties through Medicare / Medicaid  funding.
• When asked about the business case for eHealth, Dr. Blumenthal cited his personal experience as a primary care physician.  He stated that he was initially a reluctant EMR user but became a convert through a series of personal experiences.  He shared one of these stories in which an alert generated by the EMR gave him the information he needed to cancel a diagnostic imaging test that he was about to order.  Dr. Blumenthal used this personal anecdote to demonstrate that hard cost savings that are possible through immediate access to all relevant patient information.
• Thinks that the Scandinavian countries are perhaps the most advanced with regard to eHealth use and adoption.  He noted, however, that these countries are considerably smaller than the US or even Canada and are still struggling with a framework for information exchange.

Highlights of the conversation with Mr. Alvarez included:

• Accomplishments to date include:
  • Have put standards in place
  • Have defined an eHealth architecture that is used by all jurisdiction
  • 300 projects currently underway, most of which are in the implementation stage
• Every province is at  a different stage, with some provinces, like Alberta, much further along the path to having a comprehensive EHR in place.
• Have made significant progress in diagnostic imaging and telehealth
• While Infoway could have started with EMRs in physician offices, they did not feel that it was the right approach at the time.  Now that other core pieces of the EHR framework are in place, Infoway will be committing a significant portion of the recently received $500M federal government investment in to EMRs and interoperability.
• Mused about the challenges of Canadian federalism and noted that with regard to eHealth, the jurisdictions are more collaborative than they are with respect other aspects of health.
• When asked about the business case for eHealth, Mr. Alvarez indicated that Infoway has systematically examined the benefits and identified on the order of $6B in savings.  Recent studies of the benefits of diagnostic imaging and drug information systems have shown savings on the order of $1B each.
• With respect to “meaningful use”, Mr. Alvarez stated that Canada has been “muddling along” with respect to adoption metrics and will be borrowing some ideas from the US in this area.
• Mr. Alvarez challenged the belief that it is “taking so long” to implement eHealth.  He noted that the banks took decades to go from computerizing their ledgers to the on-line banking systems that we know today.  Mr. Alvarez asserts that eHealth implementation is a 10 to 15 year journey and that Canada is making good progress.

This plenary session was probably one of my favorite events at the conference.   I continue to be amazed by Dr. Blumenthal’s leadership and was pleased to see Mr. Alvarez acknowledge that Canada could learn some lessons from the US approach.

Mike

Delays in federal gov’t funding for Infoway delaying EHR deployment – Infoway

In an article published yesterday in the Canadian Medical Association Journal (CMAJ) Richard Alvarez, Infoway President, claims that “the year long-freeze on federal funding has compromised plans to rollout initiatives designed to improve physician uptake of electronic records”.  He further states in the article that “This will do nothing to improve Canada’s status as an international EHR laggard”.

http://www.cmaj.ca/earlyreleases/16feb10-electronic-health-records-initiative-stalled.dtl

Nearly a year ago the federal gov’t committed an additional $500M in funding for Infoway as part of larger stimulus package.  Commenting on the federal government’s delay in meeting this commitment, Mr. Alvarez states in the article “I don’t want to undermine things by saying that the squeaky wheel always gets oil first, but quite frankly when governments are faced with long waits in certain areas for treatment, that becomes a loud noise.  And so, some of the issues that are truly transformational in terms of patient safety, in terms of improving the efficiency, tend to get forgotten.”

I have long been an advocate for continued funding for Canada Health Infoway. What are your views on the matter?  What has been the impact on EHR / eHealth progress in Canada from the delay in Infoway funding?

Mike