New Brunswick to build province-wide health portal

By Jerry Zeidenberg

FREDERICTON, N.B. – New Brunswick is moving ahead with the creation of a dynamic web portal that will give physicians and other healthcare providers access to systems used in hospitals across the province. That means caregivers will not only have access to patient records, they would also be able to interact with the multitude of electronic solutions used in hospitals and other facilities.

“The portal will be a point of access into everything in the healthcare system,” commented Martin Ferguson, Enterprise Architect with the Department of Health.

“Increasingly, we’re faced with requests to provide access to systems and information. We needed a solution for one point of contact and access, giving the same look and feel across the board.” New Brunswick has selected AnyWare Group to provide the ‘single health portal’ solution, and awarded the company a five-and-a-half year contract.

AnyWare Group has already been supplying remote access solutions to hospitals and health regions across the province, and has been testing a chronic disease management system that itself uses portal technology.

The first phase of the province-wide health portal will be launched in December, giving access to the interoperable Electronic Health Record, lab, pharmacy and diagnostic imaging information. Other applications will be added over time, and the plan is to add other providers too, such as physician practices and long-term care centres.

“It goes beyond just being able to access patient information,” said Robert Lalonde, CEO of AnyWare. “It gives you access to transactional systems, too. So if you need to move a patient from one place to another, you can do it. And if you need to book a patient into surgery, you can use another system to do that, too, all from the portal.”

That’s in stark contrast to other portal solutions which aggregate pieces of data from patient charts, creating a static record.

“The portal is effectively the front-end to our “One Patient, One Record” strategy,” commented Carole Sharpe, Director of eHealth Initiatives in New Brunswick. The strategy aims to create a system of electronic health records for the citizens of the province, all of which can be reached through a single point of entry – the portal.

To do this, Sharpe noted that other major building blocks are being put into place, including a client registry which will enable the right patient record to be associated with the correct person. The department is working with Initiate Systems on this project.
Sharpe and Ferguson also pointed out that security and privacy are of the utmost importance in these systems, and that a good deal of work has gone into ensuring the portal and other solutions are solid.

“Security is a huge issue,” said Ferguson. “For every project we do, we conduct a privacy impact assessment and a threat risk assessment.” He noted the systems are checked for ability to resist intrusions.

That’s another reason why the rollout of the portal and the ‘One Patient, One Record’ systems are being rolled out over time. As the applications are scaled up, they can be tested to see at each stage whether they continue to perform the way they were designed.

The AnyWare portal technology is also designed with role-based systems, meaning that access to records is given depending on the role and need of the person. For example, physicians will likely need access to many types of information, while nurses and therapists may need just a portion of it. Hospital administrators may be allowed to see even less.

What’s more, a physician could be given a certain degree of access to information at one hospital and more limited access to data contained in another.

“We’re seeing doctors moving around a region much more these days,” said Lalonde. “The head of surgery at one hospital may be a consultant at another.” As such, the amount of access the physician is given at each institution can be tailored to the role he plays there.

For its part, New Brunswick has approximately 40 hospitals and health centres. Until last year, they were organized into eight different health regions, with a major acute-care hospital in each region. However, in 2008, the province decided to re-organize into two health regions to gain efficiencies in the delivery of care and in the use of administrative systems and purchasing activities.

AnyWare Group, headquartered in Saint John, N.B., offers managed, remote services through its diverse technology points of presence throughout Canada and the United States.

It has been providing remote access computing to hospitals throughout New Brunswick, including the Atlantic Health Sciences Corp. According to the company, over 100 hospitals across North America use its systems.

Lalonde said AnyWare Group has three ‘command and control’ centres in Canada that take care of the security and privacy functions needed for remote access of applications. AnyWare’s technology also provides ‘single sign on’, meaning that users log into the system once and can then reach all the applications they need. “They don’t have to remember 12 different user names and passwords,” said Lalonde. “We take care of all of that for them.”

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Infoway to invest in EMRs, interoperability and consumer eHealth

By Jerry Zeidenberg

QUEBEC CITY – Canada Health Infoway CEO Richard Alvarez told an audience at the eHealth 2009 conference, held here in early June, that the agency will spend its $500 million windfall on physician EMR systems, as well as on fostering greater interoperability among electronic solutions, establishing Infoway as a certification authority for new systems, and helping to build consumer-oriented solutions such as portals.

Ottawa announced the half-billion dollars in funding for Infoway in the last federal budget. It was made known even before the conference that Infoway would use a major portion of the cash to kick-start the uptake of physician information systems, commonly known as electronic medical records (EMRs).

However, the other initiatives and directions that were announced came as surprise – albeit a pleasant one — to many in the eHealth sector.

On the EMR front, Infoway plans to partner with provinces and territories as they roll out incentives and subsidies to doctors, effectively splitting the bills with them. “We want to accelerate EMR deployment by co-investing with jurisdictions for… up to 50 percent of their costs,” said Alvarez.

The funding for EMRs will be done on a first-come, first-served basis, with jurisdictions that are perceived to be committed to moving forward with systems for clinicians.

Alvarez noted that while Canadian hospitals are internationally praised for the use of electronic records, Canadian physicians – particularly those working outside of hospitals – are global laggards when it comes to the EMR.

Infoway estimates that only 17 percent of Canadian doctors are using electronic medical records; the agency would like to see that figure boosted to 50 percent in two years time, with 35 percent making ‘meaningful use’ of the applications – a term borrowed from the U.S. as the Americans plan to invest some $19.2 billion in healthcare IT as part of the recent stimulus package.

In handing over $500 million in cash to Infoway, the federal government is asking that several objectives be met.

In addition to much higher usage of EMRs by doctors, the feds also want to see integration of the systems – with other EMRs and with hospital-based systems. Only then can physicians communicate with each other and obtain the records and test results they need to make EMRs worth the trouble

As such, Infoway will extend its standards campaign – something it has emphasized in the hospital world — into the physician system arena.

“Infoway will be the eHealth certification authority,” said Alvarez. “Vendors will need to enhance their products to achieve the prescribed level of interoperability.

“We will certify all emerging solutions,” he added.

Interestingly, he said that Infoway will also invest in EMR companies, although he didn’t go into the details.

Alvarez said Ottawa also wants to see progress made on the consumer side of eHealth, with support for electronic systems that give patients better access to their own records, along with the ability to make appointments with healthcare providers and the development of resources for self-care.

“Canadians don’t want to sit in ERs or doctors’ offices unnecessarily,” commented Alvarez. How that translates into programs and funding from Infoway is unclear, as Alvarez didn’t elaborate on what role the agency will play in fostering personal health record systems, the ability to make online appointments (something reminiscent of the ‘choose and book’ system in the United Kingdom) or other online tools.

Ottawa is also interested in the generation of jobs through its investments. Alvarez said, and the agency will be monitoring how many knowledge-based jobs are spawned through its investments.

He acknowledged that success in eHealth will not necessarily be achieved simply by doling out funds. There are many possible stumbling blocks and hurdles that will have to be dealt with.

As examples, Alvarez mentioned ‘project slippage’ as a factor, the propensity for projects to run late for various reasons. Slower than expected clinician uptake of systems is also a factor – something that can happen despite the best of intentions of project planners and managers.

Still, at a time when many public agencies were left high and dry for additional funding in the last federal budget, Infoway lucked out with the allocation of $500 million — in obtaining the cash, it appears the agency was the beneficiary of political winds and developments in the United States.

Indeed, Alvarez credits the emphasis put on eHealth by the new administration of President Barack Obama in the United States as influencing policy makers in Canada. “In saying how essential it is… it really helped our case,” said Alvarez.

That said, he noted the government and Canadians themselves will want to see ‘visible progress’ in the modernization of the healthcare system over the next two years.

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Patients increasingly seeking control of their own health records

By Andy Shaw

TORONTO – Kevin Leonard, PhD, opened the jam-packed One Patient, One Record symposium he staged in Toronto by saying he yearns for the day when the 19 specialists who treat his Crohn’s disease can consolidate their silos of separate data on him into a single electronic health record – one he can call his own.

Dr. Leonard, a health policy professor at the University of Toronto and an eHealth research scientist, ended his symposium later in the day by introducing wind-up speaker Diane Carmichael, president of Best Doctors Canada – who told of one recent chronic care patient needing 2,500 lab tests, imaging, notes, and other bits and pieces of medical evidence electronically stitched together to form a complete personal record, and yet another who had 5,000 such items.

In between, Leonard also introduced a parade of nine other presenters. Through their research or personal experience or often both, they all knew just how rewarding and yet how complex a job it is to assemble a meaningful electronic health record that tells the patient’s whole medical story.

Yet one such story may help revolutionize patient record keeping.

“About 10 years ago my mother-in-law was battling breast cancer and she was truly inspirational,” said keynote speaker David Wiljer, PhD. “She wanted to know everything there was to know about her condition and share it with everyone else like her. And she did. She even built a website without knowing at first quite what a website was.”

Utterly inspired by her innovation and courage, Dr. Wiljer changed careers from biblical scholar and is now director of Knowledge Management and Innovation at Princess Margaret Hospital in Toronto. There he advances what his mother-in-law started by way of patient empowerment.

Dr. Wiljer gave details of the empowering “Infowell” web portal project for chronic patients he directs at Princess Margaret, one of the three major Toronto hospitals forming the University Health Network (UHN). It is re-shaping traditional notions of Canadian patient information and record keeping.

“We’re advancing a new paradigm of patient information for the benefit of both the patient and the healthcare system,” explained Wiljer. “And there are three levels of information a patient needs in order to make fundamental decisions: clinical information about their disease, experiential information of other sufferers, and at the top their own medical record. We’re working at improving UHN patient access to all three levels with Infowell.”

Dr. Wiljer is the founding Chair of the Canadian Committee for Patient Accessible Electronic Health Records (CCPAEHR), dedicated to involving patients in the design and use of their records.

Dr. Alexander Logan and Joseph Cafazzo, PhD, joint researchers from the UHN’s Centre for Global eHealth Innovation, spoke of the “tyranny of acute care” records and how ubiquitous remote monitoring by cell phones may soon earn chronic care records their rightful place.

Dr. Daniel Sands knows about patient trust. He is a Harvard Medical School grad and professor but also works as a physician at Beth Israel Medical Center and as a healthcare consultant at Cisco Systems. However, he’s best known in health record-keeping circles as the partner of “patient Dave”.

Dr. Sands related how he had encountered Dave deBronkart after his routine X-ray for a shoulder injury revealed wide-spread renal cancer. Together they began a journey they are still on together battling Dave’s cancer and staying connected through every electronic weapon at their disposal.

deBronkart himself has emerged as an “eHealth” champion and is the featured speaker at a Toronto conference later this year.

“Most patients struck by a life-threatening disease feel very isolated,” said Dr. Sands. “But Dave says bluntly he doesn’t. Instead he says he feels empowered – empowered by the electronic access he has had to his records and to possible treatments, which he has responded well to.”

Dr. Sands went on to say he hoped together they are showing how to forge a new relationship between doctor and patient.

“I think we are finally moving away from the ‘information asymmetry’ (angled in favour of the provider) that has characterized the relationship in the past,” concluded Dr. Sands.

Just how asymmetric patient record-keeping can be, especially for chronic care patients, is well known to Dr. George Tolomiczenko, a PhD scientist who heads up the Crohn’s and Colitis Foundation of Canada (CCFC). He spoke of the role that chronic disease associations play in promoting the one-patient, one-record goal, despite the complexities involved.

“One chronic disease is difficult enough. It may take, for instance, two years (of tests and record keeping) before something like Crohn’s disease is even diagnosed. Then as people age they tend to have more than one chronic disease,” Tolomiczenko told the symposium.

So the challenges then of networking a patient’s caregivers are also multiple. Tolomiczenko said, however, that today’s social networking phenomena, such as Facebook, point to one promising path through the complexity.

When it comes to simplifying the complexity of privacy connected with electronic records, speaker Ken Anderson, Ontario’s assistant privacy commissioner, said the Ontario healthcare system was well positioned as a result of its pro-active approach. He reported that his Office, under Commissioner Ann Cavoukian, has been working with Microsoft HealthVault, Google Health, and Mayo Clinic officials, as well as with Canada Health Infoway and the eHealth initiative in Ontario to protect systems for storing and sharing complex medical records.

Final speaker Diane Carmichael offered startling evidence of what can be accomplished when patients actively champion their own health and build their own records – albeit with expert help.

Her Best Doctors Canada organization connects clients with a vast network of the world’s top specialists, largely for second or third opinions. It is utterly thorough in gathering a complete medical record for each patient being assessed, even if it means gathering 5,000 pieces of evidence.

“In one case recently a patient had an abdominal tumour removed and the pathology had come back indicating she was palliative and untreatable,” said Carmichael. “But we looked at the records of where the pathology was done and had her completely re-tested. The results came back that she was indeed treatable. The expert we used to examine her records said he suspected there was a staging error in the original pathology.”

In another case, a patient was facing surgery to remove a spinal tumour that would, he was told, result in paralysis if he chose to go ahead with the operation. But then on his behalf, all his records were gathered by Best Doctors Canada, which in turn ordered a different work up of tests and consequently changed the diagnosis. The patient then decided to have the tumour removed and he’s still walking.

“In short, we’re helping patients make better decisions about their treatment,” said Carmichael, who is also on the advisory board of the Canadian Association of People-Centred Health.

Carmichael added that where treatment is dependent on pathology interpretation, Best Doctors Canada on average changes the recommended treatment for a whopping 55 percent of the cases it examines.

Could there be a better argument for one complete and accurate record for every one of us?

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