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Consortium aims to create intelligent healthcare portalBy Jerry Zeidenberg TORONTO – A group of Ontario hospitals, universities and private-sector partners have joined forces to solve one of the biggest problems in healthcare I.T. – the inability to access data quickly because of incompatible systems. “Clinicians who move between healthcare organizations are forced to contend with information silos and disparate clinical information systems daily,” said Dr. Lynn Nagle, senior vice president, technology and information management at Mount Sinai Hospital, one of the participating organizations. “This initiative just might be the solution we’re seeking.” Funded with $2.4 million from government agencies and partner contributions, the group aims to create the first ‘intelligent’ web portal – one that can bring forth a host of relevant information related to particular patients and their conditions. Phase one of the project is expected to be up and running this October. Using the Internet for connectivity, the partners plan to employ unique middleware and database technologies to pull together various types of medical information from a variety of sources – lab, radiology, ADT, pharmacy, regardless of the location or data format. Whether the records are stored in Meditech systems, MediSolution, Cerner or any others, it makes no difference, as the new solution will be able to access them all and present data in a way that make sense to the doctor, nurse or administrator who needs information. “Billions of dollars have been spent on collecting data in the healthcare system, but it’s very difficult to get at it and bring it to the user,” said Ehud Cohen, a partner with Data Glider Ltd. of Richmond Hill, Ont., an R&D company and project leader for the consortium. “The problem is that we’re data rich and information poor.” “We want to be able to access different data sources and give healthcare professionals the right data at the right time, at the point of care,” said David Lewis, director of marketing with Data Glider. In addition to DataGlider and Mount Sinai Hospital, members of the consortium are Lakeridge Health Corp., Oshawa; Credit Valley Hospital, Mississauga; Department of Medicine, University of Toronto; Computer Systems Group, University of Waterloo; Centre for Global e-Health, University Health Network, Toronto; and Compugen, Inc., Richmond Hill (a large, systems integration company that’s handling project management and commercialization of the system.) The group recently obtained project funding of $800,000 from Precarn Inc., an Ottawa-based economic development agency, and $150,000 from Communications and Information Technology Ontario (CITO), a division of Ontario Centres of Excellence Inc. The remainder of the $2.4 million development budget will be provided by the member organizations. The plan is to commercialize the technology, when it is completed, and to market it to hospitals across North America. Web portals to access information are not new, and many hospitals are already using them. But Cohen noted there are significant differences between these existing portals and what DataGlider and its partners are envisioning. First, he asserted, most portals can only access information that’s contained in the hospital’s own information system. By contrast, the consortium’s system will be able to quickly access data stored in any repository, regardless of the vendor or location. Moreover, the group’s portal will enable the end user to customize his or her view, altering the interface so that only the information sources that are needed are presented on-screen. Most portals today present a fixed view that can’t be changed by the end-user. Finally, some hospitals and health regions are using middleware or integration engines to bridge disparate islands of information. But Cohen said it’s an inefficient way of doing the job, as integration engines usually copy all of the data onto a central site. That creates storage, synchronization and timeliness problems. These problems multiply as you extend the reach of the system to long-term care, pharmacies, physician practices and other providers. Copying all of the data becomes a massive, unwieldy project, he said. For its part, the consortium’s technology will leave information wherever it may be, and pull it together as needed. “A better approach is to leave data where it is, and to link it in real-time,” said Cohen. “In this way, we create a ‘virtual’ electronic record.” Finally, there are other approaches to integrating incompatible systems. For example, the U.S.-led Integrating the Healthcare Enterprise (IHE) is establishing standards by writing ‘profiles’ for thousands of transactions that occur in the hospital and healthcare setting. (See article in Canadian Healthcare Technology, June/July 2004.) While the IHE is making progress, it’s a time-consuming and painstaking process. DataGlider and its partners are taking more of a big-bang approach that seeks to establish connectivity in one fell swoop. Intelligent middleware and web portals not only ensure that all information is accessible, but also that it can be personalized for each and every user. Simply put, the user’s computer screen is divided into blocks representing ‘portlets’, which access various streams of information. For example, a physician who needs access to lab, pharmacy, ADT, patient histories, and orders can select these for display on his or her screen. The information for all of these applications will be available within seconds, with no need to log-in or log-out. “It’s there simultaneously and seamlessly,” said Lewis. “It’s all done with single sign-on. You don’t have to bother with log-ins to various systems.” Cohen said the project was originally sparked by ‘visionaries’ at the three hospitals that are part of the group – Dr. Lynn Nagle at Mount Sinai Hospital; Jamie Bowie, director of information technology at Credit Valley Hospital; and Deborah Anthofer, program leader, information technology, at Lakeridge Health Corp., as well as by Dr. Alejandro Jadad, director of the Centre for Global e-Health, part of the University Health Network and the University of Toronto. They realized that costs for accessing information sources were escalating, with no quick solutions in sight. They got the ball rolling on the new solution, one that would create a virtual electronic record on a regional basis to start, and possibly integrating records province-wide or even nationally. The hospitals and the Centre for Global e-Health are conducting the research into what physicians, nurses and other professionals need from the system, so the right sources of information can be accessed. The Department of Medicine at the University of Toronto is providing research into the way the system can be optimized for physicians’ workflow, while the University of Waterloo is developing a declarative reporting engine for presenting information to physicians in simplified ways. Said Dr. Nagle: “The intelligent e-health portal will also provide clinical decision-support tools such as reference databases and best practice guidelines. Future applications of this solution are endless.” Moreover, by pulling up disparate sources of data, such as ADT, lab reports, medication histories, diagnostic images and radiology reports, it will save physicians the time and trouble of logging in and out of these systems. “This is where we improve the workflow issue for doctors,” said Lewis. “Bringing information together in this way will also help reduce medical error, which lowers costs for the hospitals and improves the quality of care for the patient.” Dr. Nagle noted that by creating a common front-end interface for doctors and other healthcare professionals, substantial training costs can also be controlled. “As clinical applications have evolved, we’ve been asking more of people’s time for training,” she said. “And we’ve been competing for training time with other things, like clinical education. “Conceivably, if the portal concept were to be widely adopted, clinicians could be trained once on the intelligent e-health portal and easily adapt to many different systems, in many different healthcare organizations,” said Dr. Nagle. She is also delighted with the technologies developed by DataGlider. “The potential for their solution to address a system-wide problem is enormous,” she said. BACK TO TOP OF PAGE
Q & A: Alvarez outlines strategic vision for Canada Health InfowayBy Andy Shaw When the Board of Directors of Canada Health Infoway Inc. (Infoway) announced the appointment of Richard Alvarez as Infoway’s new CEO in January this year, he was lauded for bringing “a unique blend of senior leadership experience and passion to his new role” that would “help move Infoway to the next level” in its efforts to create a pan-Canadian electronic health record (EHR). Mr. Alvarez’s leadership experience includes heading the Canadian Institute of Health Information (CIHI), and serving as assistant deputy minister with the Alberta government’s Information Technology and Health Care Insurance divisions. Recently, CHT’s contributing editor, Andy Shaw, caught up with Mr. Alvarez, to check on his progress at Infoway after six months on the job. They spoke in London, Ontario at St. Joseph’s Health Care, on the heels of short ceremony celebrating the first phase completion of the Southwest Ontario Digital Imaging Project. At the event, Alvarez presented an Infoway cheque to St. Joseph’s for $891,000. CHT: Richard, you clearly relish rewarding success. Alvarez: Yes, Andy, we do. The money that I handed out today was the reward for the project’s success. It was not money for what St. Joseph’s might or what they plan to do next. It said in effect, we have seen the system that we both agreed to, in action. You also promised you would get your clinicians on side with the new system, and you did. It is all there and it all works. So now, here is the cheque. In effect, that represents a way of doing business in healthcare in Canada that is so far unique. CHT: Speaking of doing things differently, has Infoway changed in other ways as a result of your arrival? Alvarez: I would say my arrival has not changed Infoway so much as it has sharpened its vision. I helped our Board of Directors set some new priorities, and now we’re working hard at communicating those priorities. Fortunately, because of what I was able to achieve previously at CIHI and in Alberta, people seem to be listening. And I think that has helped Infoway, in particular, get its message through that we are not a grant-funding organization, but rather a strategic investment agency. CHT: Why is that message such a priority? Alvarez: Well for one thing, there is an impression out there that Infoway has been sitting on its money. But you know, in this business we could just sit back and throw money and technology at a healthcare problem and not hold people very accountable. But we would then be in grave danger of building a system and then no one comes – because they have not bought in. And for some that is a real struggle, because we insist that hospitals do what they have to do, as they have done at St. Joseph’s, to get total clinician buy-in. We do not give away money without that kind of accountability. CHT: What are your other priorities then, speaking both personally and for the organization? Alvarez: (with a grin) Well personally, I have just three priorities in my job: communicate, communicate, and communicate. For Infoway, we have two fundamental priorities and they are to improve the quality of care and to heighten the healthcare system’s level of safety. They form our bottom line. But there are a lot steps needed to get to that bottom line. The biggest one is to get people in the system to change, to adapt, and to adopt new ways of doing things that technologies enable. CHT: How do you avoid that then? Alvarez: Through another one of our priorities: partnerships. We are not doing this alone. We are making partners with provincial healthcare policy makers and their administrators. We are making partners of regional health authorities, and most importantly, we are now also striving to make partners of the individual clinicians out there. And that is absolutely key. As you know, we as a national agency do not have direct control over them or their businesses. So we have to find other means. CHT: What has Infoway learned from its experience, so far? Alvarez: That if an EHR project is to be successful, you need a clinician-leader. Someone who has been converted. Someone who has seen the light. That’s why we’ve brought in a clinician from Kamloops, for example, to serve on our Board. We need to hear that voice. And it’s why we’ve also brought in a Toronto-area physician who is a convert to technology. She will maintain her own practice, but also work for us as a consultant, four days a week. She’ll help us figure out how we motivate other Canadian physicians to adapt to new systems, remembering that the great bulk of them were trained in medical schools long before computers were part of the curriculum. So we need to teach them new tricks. That’s really the next level we’ve got to get to. CHT: What other goals have you set for Infoway? Alvarez: Our overall goal is to have 50 percent of Canadians on some sort of electronic health record by 2009. Basically by then, we want at least half the population to be able to walk into a physician’s office anywhere and have a variety of information about them pop up on the physician’s screen so that he or she knows at least: what medication the patient is on; what tests have been done; and what the results of those tests are. From there, we then want to build on systems that enable the community physician to order more tests if needed, prescribe electronically, move diagnostic images to specialists for referrals, and get their feedback. These are among the six or seven basics we’ve identified as constituting the electronic health record we want in place by 2009. CHT: Is that achievable? Alvarez: No and I hope yes. I showed our plan, for instance, to my counterpart in the United Kingdom (where the government is spending about $15.2 billion on developing a national EHR). He asked how much we had to spend to accomplish the plan. I said $1 billion and he said with only $1 billion your plan is going to fail. And he’s right. Our Infoway money, for instance, doesn’t go at all towards putting computers into physicians offices, where the whole system has to really start. So when you add everything up that you need to have in place for a country-wide electronic health record to work here, we estimate it will take something on the order of $8 billion. That’s a lot more money than we have available now. CHT: So what can you do about that? Alvarez: Well, first we are working on a thorough costing of what it truly will take. And then we are going to draw those costs to the attention of the Deputy Ministers of Health who are our members. We’re going to make it clear to them that if they are talking about reforming the healthcare system, and improving the quality of care, they can’t do it without introducing more technology throughout the system. And that can’t be done for $1 billion. However, since Infoway operates on the principle of 50 percent shared investment, then through our partnerships I believe we could leverage $4 billion up to the level of funding we actually need. CHT: What would you put that extra money into? Alvarez: So far, we’ve been supporting things like the development of electronic drug information, lab information, patient registration, diagnostic imaging, telehealth, and health surveillance (think SARS) systems. And we would continue to do that. We would fund more initiatives that meld those systems together. But we’ve already found that a high proportion of new technology costs, at least one-third of them I would say, are people costs. It does take a lot of familiarization and training to make sure that people use the new systems. So we would invest substantial funds on the human side of the equation in order to encourage the uptake of technology. CHT: How then do you plan to meld these systems together? Alvarez: One of the things we are planning to do soon is to develop a three-year investment and jurisdictional plan at the provincial level. So we and the provinces can say, if our goal is an EHR for 2009, here’s what we’ve done, but here’s what’s still missing. So here, and here, and here, is where we have put our money and our efforts if we all are going to get there in time. While doing that, we’ll be investigating what they can save, and it promises to be very significant, from banding together and using their collective buying power to purchase the new technology. BACK TO TOP OF PAGE
Calgary Health Region outsources HR to Telus, brings in PeopleSoftBy Jerry Zeidenberg The Calgary Health Region recently struck up a partnership with Telus to create a human-resources outsourcing company called Telus Sourcing Solutions (TSS), and subsequently outsourced many HR staff to the new organization. Earlier this year, 170 members of the Calgary Health Region human resource team became employees of TSS, which focuses on HR services in the healthcare and public sectors. The non-financial limited partnership is said to offer many benefits to both parties, including the modernization of the HR infrastructure for the Calgary Health Region. While Telus seems on first glance to be an unlikely candidate for an HR outsourcing venture, in truth, the company has won plaudits for its expertise in human resources, with its managers speaking on the topic around the world at HR conferences. Moreover, the company is well-versed in the technologies that are revolutionizing HR, such as the Internet and Web solutions, and sophisticated information systems like PeopleSoft. For its part, Telus won out over many others in reaching an HR deal with the Calgary Health Region “There were 15 responses to our request for information, and three finalists,” said Duncan Truscott, vice president of people and learning with the region. “The Telus consortium offered the most benefits to the region.” As part of the 15-year deal struck with the Calgary Health Region, TSS is investing $20 million in technological infrastructure to upgrade the workings of HR in the region. The investment, which will be made in the first three years of the contract, includes an extensive PeopleSoft implementation. “For us, it’s a major capital-cost avoidance,” said Truscott. He noted that the region will obtain all of the benefits of upgraded equipment and PeopleSoft software, along with implementation and change management services. “For the health region, it’s a superb way to reduce costs, improve quality in HR, and it also lets them concentrate on what they do best – which is healthcare,” said Stephen Bayliffe, who leads Calgary-based TSS. Bayliffe, a recent arrival from the United Kingdom, has a long history of success in human resource management with a variety of consulting and telecom companies throughout Europe. Moreover, the issue of upgrades, training and maintenance is no longer a problem for the region. “It’s our headache now,” quipped Bayliffe. And the learning curve is expected to be speedy, as Telus brings its own expertise in PeopleSoft. As a company specializing in HR services, TSS will also be able to continuously bring ‘best practices’ into the workforce, especially in the area of technological solutions to HR information needs. The Calgary Health Region is going live with phase one of its PeopleSoft implementation in October 2004, followed by phase two in April 2005. Truscott says phase one will focus on transaction-based activities, like payroll and benefits, while phase two will bring more strategic functions into play, such as succession planning and recruitment planning. The Calgary Health Region is paying TSS for running various HR operations. However, the pressure is on TSS to meet performance targets, such as quality and accuracy indicators. Examples include accuracy in processing payroll for the 23,000 healthcare employees, and the speed of handling customer requests for information. Customer satisfaction will be part of the matrix, with the customers comprising the 23,000 regional employees. The Telus-Calgary Health Region deal is a good example of a public-private partnership that will ultimately produce significant benefits for both organizations, the participants say. Truscott noted the 2002 ‘Mazankowski Report’ recommended that hospitals and health regions look to opportunities to ally with the private sector in non-clinical areas, when the evidence shows a clear advantage to the healthcare system. The report, named after former federal Finance Minister Don Mazankowski and commissioned by the Alberta Government, examined the sustainability of the Canadian healthcare delivery system and made suggestions for improvements. Truscott said the partnership with Telus provides a means to cost-effectively modernize HR in the region. “Previously, we had only basic payroll, with no real HR functionality on a regional basis,” he noted. Now, in partnership with TSS, and through the use of PeopleSoft solutions, the stage is set for a wide range of improvements in HR activities across the region, from payroll and benefits to collective bargaining, on-going education, and workforce planning. The partnership puts the Calgary Health Region in good shape to deal with future growth in services and staff. The CHR is currently the only region in Canada to be constructing two standalone hospitals. The Alberta Children’s Hospital, scheduled for completion by August 2006, and the new South Hospital, which is expected to be opened in 2009. The high-tech South Hospital will contain 350 beds in its first phase, but could be expanded to 800 beds as early as 2013, if needed. BACK TO TOP OF PAGE
Performance management: software is only one part of the solutionBy Dianne Daniel When it comes to improving the quality of Canada’s healthcare system, a growing number of organizations are embracing performance management software as a means to measure where they are today and understand where they need to head in the future. As Terence Atkinson, director of public sector industry solutions for Cognos Inc., of Ottawa, suggests, there’s a realization that in order to improve performance, hospitals need to better understand their ‘business.’ “They have been collecting data in a variety of systems for a long time, but they just haven’t been able to turn it into information that helps them to run their hospitals better,” says Atkinson. While performance management software products like Ottawa-based Cognos’ Enterprise Business Intelligence (EBI) and Toronto-based Panorama Business Views’ pbviews balanced scorecard solutions are important, the transition from a data rich organization to an information rich one involves much more than a technology implementation. “Buying software is one piece,” says Don Gordon, president of Toronto-based Praxia Information Intelligence, a technology-independent consultancy specializing in decision support for healthcare. “What fundamentally makes (performance management) work or not work is an organization’s ability to translate the data into relevant information,” he says. According to Gordon, hospitals need to first create a culture of evidence-based decision making that involves understanding what they need to measure, where the information is located, how to get it into a performance management system and how to massage it in order to produce good information. “Frankly, to me the technology purchase comes last and it’s not that significant,” says Gordon, whose company has worked with clients to implement software from Cognos, Panorama, Microsoft and others. Bloorview Macmillan Children’s Centre, a children’s rehabilitation hospital in Toronto, is successfully using Cognos Power Play and Matrix Manager products to help create a central information resource for executives. Getting the senior management team to speak the same language was the first hurdle to overcome, says director of decision support and planning Hakim Lakhani. “In healthcare we have pockets of information among finance, health records, information technology and human resources; they all keep their own data and there are political- and turf-related boundaries,” he says. “At the corporate level there’s no structure that promotes the sharing and optimizing of information.” To change that, Bloorview Macmillan took the important first step of creating a decision support framework to serve as a central information resource. Whereas in the past, user requests for information would be “sprayed and prayed,” meaning business analysts would start by sending requests out to various departments and then sit back and hope for an answer, now all disparate data sources are pulled together using Cognos software so all data can be accessed from one place. As Lakhani explains, executives at the vice-president, director and manager levels across the hospital are given a desktop icon enabling them to go to one central site on the network in order to retrieve data. By clicking on folders such as Finance, Workload, In-patient Data or Human Resources, for example, they can either scan predefined views of information or create their own custom reports. One of the biggest changes, he says, is that various departments have started to work together. “They’re actually working as a decision support team which is very encouraging for me. We get answers together and people don’t have to spray and pray anymore.” One key advantage for Bloorview Macmillan is it already had much of the data required to support its performance management system linked together in a central data repository. Otherwise, having the IT manpower and technology required to sustain ongoing data integration can be a significant stumbling block, says Praxia’s Gordon. At William Osler Health Centre, a hospital corporation serving the communities of Brampton, Etobicoke and Georgetown, Ont., the lack of a computerized interface to automatically populate Panorama’s pbviews slowed widespread acceptance of the software prior to the amalgamation of the three hospitals it encompasses. “Initially ... there was a lot of labour put into populating it and maintaining it, and in terms of a monthly monitoring tool it was very difficult to maintain,” says director of planning and decision support Gary Spencer. “For us, things really took off when we purchased our data repository and it allowed us to link information from our clinical systems.” William Osler Health Centre uses its balanced scorecard tool to measure four main quadrants of information, similar to those monitored by the Ontario Hospital Association: financial performance, utilization and outcome, patient satisfaction, and integration and change. By mirroring its performance indicators after the OHA’s measures, the centre is able to stay ahead of the curve, says Spencer, and be proactive in dealing with information that will eventually be public knowledge. “That was a good starting point, but we further massaged it by holding focus group sessions with our ‘manager, director, VP’ group to identify what were the critical indicators of performance that fell within those four quadrants,” says Spencer, adding that the financial indicators were easy to provide, while the others presented more of a challenge. One lesson learned by William Osler Health Centre: you need to start small when implementing performance management software. Through ongoing discussions with its user community, the IT staff realized that too much information is sometimes an inhibitor rather than an enabler. “When we did our customer satisfaction survey with our managers, they said bells and whistles are great, but all we need to know is, what do we need to look at in terms of our performance and make it as simple as possible,” says Spencer. “If we have time we can use these other features, but first and foremost, make it easy for us to find what we need in order to manage.” With the growing push for accountability in healthcare across the country, Praxia’s Gordon predicts the need for good information within hospitals is only going to get stronger. He advises hospitals to think of performance management system implementations as a three-pronged approach that requires understanding what to measure and why, selecting a robust performance management system, and finally, creating a shift towards evidence-based decisions so that managers are comfortable with and know how to use the information provided.
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Consortium aims
to create intelligent healthcare portal