Health Informatics insights: remote health monitoring

I just got better from a month long ordeal with an infection, which required daily visits to a care provider to assess the state and provide care. Though, the care was exemplary by Ontario CCAC, there are areas of improvement needed in care coordination among providers and remote health monitoring to increase efficiencies.

Remote health monitoring, means different things to different people.  The following report from California Health Foundation offers the current state of the market with a clear definition on the terms and the state of the market.

The Connected Patient: Charting the signs of remote health monitoring

Image Source: California Health Foundation – The connected patient: charting the vital signs of remote health monitoring.

Key insights: little has changed in the last four years with mixed results from pilot projects

Why little has changed when the economic benefits offer several millions and billions of dollars in savings and efficiencies ?   The author of the report points to the structural issues of the US health care system, which tends to be fragmented and focused on episodic care.  I believe that this is not just a US problem and is a common issue between the publicly funded Canadian healthcare& and friends south of the 49th parallel.  By far the biggest barrier to more pervasive adoption of DM has been the continued fragmentation of operations and information technology across health systems.

That is a well known problem with the providers paid on a fee for service basis.   In the US there are recent developments with the introduction of HITECT act and Accountable Care Organizations towards an outcomes based system.  In Canada, from my view the change appears even slower and the outcomes based model is being discussed at the provincial level, who are essentially payors of the service.

Though there are several drivers for remote health monitoring including communication technology advancements, mobile data standards, the chronic care tsunami we are facing as a society,  there are some significant challenges in adoption at the physician office,  consumer engagement and payment models for this service.

In spite of the challenges there are significant economic benefits and prospects to remote health monitoring both in US and Canada.

& Rethinking Our Approach to Disease Management: Technology and Information Flow Considerations

Ontario EMR Specification v4.0 FINAL version released

Ontario  EMR version 4.0 specification(final) was released couple of days ago by Ontario MD for EMR vendors to apply for funding offering and comply with version 4.0 requirements.

 

Here is the link to the schedule and version 4.0 requirements.

https://www.ontariomd.ca/portal/server.pt?space=CommunityPage&cached=true&parentname=CommunityPage&parentid=4&in_hi_userid=2&control=SetCommunity&CommunityID=553&PageID=1763

Version 4.0 has some key requirements from a jurisdictional EHR or document exchange between healthcare provider point of view.  One of the key requirement is the requirement for EMR vendors to implement Hospital Report Manager specification to enable transfer of clinical documents like discharge summaries, transcribed reports (radiology, lab and others) from healthcare providers (mainly acute care hospitals) to primary care physicians(PCP) using an EMR.

This is great first step forward to enable the family doc to receive discharge summary from the hospital before the patient shows at the doc’s office and EHR.  Though at a provincial level this standard (Hospital Report Manager) doesn’t seem to align with the Ontario Clinical Document Specification, which is currently under public review as well.

Friends at eHealth, kindly take a note of this.  I am reviewing the CDS and will be submitting my comments through the public review forum as well.

Saravana Rajan

eHealth Ontario Update

Diabetes Registry:

Provincial Diabetes Registry Contract announced and goes to CGI for $46.2 million.

Musings from eHealth Ontario CEO Greg Reed:

eHealth Ontario’s CEO Greg Reed’s musings on the role of eHealth Ontario

Source: eHealth Musings blog by Michael Martineau

mobile health: iPhone goes enterprise in Canadian Hospital

Mobile health hits the road with iPhone, where Palm once a good position and Blackberry to failed to utilize the opportunity and iPhone is expected to roar with success.   That’s innovation given iPhone’s usability, which is very “vital” for Healthcare.

Mount Sinai Hospital in Toronto created a mobile patient chart application in iPhone  accessing data from 66 different applications.  I guess that this was an year long project  instead of the usual norm of  multi-year projects given the amount of stakeholder engagement and legal regulations surrounding patient privacy and security, which in itself is a commendable achievement.

Also a common scenario in many hospitals today is too many devices and desktops and smartphones used by clinicians as quoted in the Canadian Healthcare article.

“He(CIO of Mount Sinai) also noticed that clinicians were accessing too many devices – cell phones and smartphones, pagers, large, clunky nurse-call devices, plus desktop computers at various workstations. Far better, he realized, to have one device that could serve as a gateway to everything. And the more portable the device, the better. That’s where the Apple iPhone came in. ” Source: Canadian Healthcare

It will be interesting to find out, whether the clinicians access it as single application with relevant sets of data(from the 66 different applications) for a patient and context sharing between them instead of 66 different iPhone applications.

The VitalHub project is getting turned into a business, to commercialize the solution and offer the iPhone accessible Patient Chart to other numerous interested hospitals.

Saravana Rajan

Upcoming important Healcare IT Events in Canada

September 8, 2010

1. ITAC Health / MEDEC Patient Management Software Conference

Given the recent Health Canada’s rules on medical device classification rules  and the requirement for all patient management to be certified as class II has an impact on vendors/distributors selling products in Canada.

This is quite an important event for both the customers and vendors to understand the new requirements and network with others who are undergoing the process.

October 4-6, 2010

IT Healthcare Canada conference and exhibition

This event is organized by Ontario HIMSS chapter and the first time the chapter is organizing an event of this size, which is quite an amazing feet.  Kudos to the organizers and I wish them all the success.

Plus: Low registration fee and you can network with regional health leaders to understand where eHealth is marching towards in Canada.

Saravana Rajan

Happy Canada Day! and eHealth good news from Canada

Happy Canada Day everyone !

News (good and bad) from Canadian Healthcare Technology World!

Good News First –

NEODIN (North Eastern Ontario Diagnostic Imaging Network) a diagnostic imaging(DI) repository that will connect all north eastern Ontario hospitals shown in the map below for sharing diagnostic images and results has connected one more major hospital, Thunder Bay to the DI network.

As stated in the Canada Health Infoway press release here, benefits of a DI-R are

• Enables diagnostic images and reports to be shared between facilities, eliminating the need for patients to transport images and reports between doctors on CDs, films, or by fax.

• It also allows specialists at one facility to access the reports for images acquired at other hospitals allowing for faster and more convenient information sharing between doctors. This improved access to patient information will help health care providers make more informed and timely medical decisions.

• Helps reduce duplicate testing that results from lost, misplaced or otherwise unavailable images

One more step closer to EHR!

Congratulations to NEODIN!, Infoway and eHealth Ontario.

Bad News –

Province of Manitoba’s eHealth program is in the news for wrong reasons.

The eHealth program will be slow (another 20 years) and will cost more (another $450 million).

Here is the link to the article and a perspective from Michael Martineau, who has spent time analyzing the Canadian eHealth market with a market research firm.

Saravana Rajan

ehealth Consultant

healthcare…once upon a time!

“Once upon a time, going to your doctor was simple. You knew his first name, or perhaps just called him “Doc.” He lived just down the street and made house calls. And if you were sick, you would see him that day, because, well, you were sick” … that’s how the story starts for Hello Health! (founded by an American and Canadian in NY)

Hello Health attempts to make healthcare simple and accessible to patients and promises  to taking medicine to its basics.  With Hello Health, you can interact with your doc in your favourite means of technology.  If you have query and you would like to just e-mail, you just e-mail and its Free!  You make your appointments online and access your records as well.

At the primary care level, as the first point of contact for the patients, accessibility and responsive care is crucial for patients and especially for patients with chronic diseases like diabetes, cancer, heart disease and COPD.

So is Hello Health disruptive ? Absolutely in private healthcare market like US, its bringing the medicine back to basics and attacks the complex payer/physician centric model.  In market economics, as the value propositions of the consumers change, new players emerge to provide the missing value and this is often called as invisible hand and works in most cases. It remains to be seen whether it will work in healthcare.

Can a service like Hello Health, work in a single payer system like Canada ? Of course, it can, provided it meets the regulatory requirements of the government and the docs adopt the government certified EMR

Hello Health!

(Electronic Medical Record), of course with lots of incentives.

Accessing a primary case physician is  relatively easy (caveat: if you have a family physician) in the Canadian Healthcare system and every one is aware of the improvement needed in terms of technology adoption.

In US, the question remains whether the proposed mandatory legislation by Obama administration can hinder a service like this. Boston Globe has a good coverage on this. http://bit.ly/WE67p

Also this type of pay for use service only serves the basic healthcare needs and Can it fix the completely ailing US healthcare system, where complex care consumes most of the resources in the system ?

It remains to be seen and the quest for solving the healthcare puzzle continues.

EMR (eletronic medical record): does it exist in Ontario ?

Electronic Medical Record as defined by HIMSS Analytics is an application environment composed of the

• clinical data repository
• clinical decision support
• controlled medical vocabulary
• computerized order entry
• provider order entry
• pharmacy and
• clinical documentation applications

This environment supports the patient s electronic medical record across inpatient and outpatient environments, and
is used by healthcare practitioners to document, monitor, and manage health care delivery within
a care delivery organization (CDO) like a hospital / clinic / doctor’s office and imaging centers.

The data in the EMR is the legal record of what happened to the patient during their encounter at the CDO and is owned by the CDO.

If you still have confusion between EHR and EMR, please refer to this document published by HIMSS Analytics which explains the difference and does a good job.

So where is Ontario in terms of EMR implementation compared to the United States.

Why SAAS or Cloud Computing may not be the way for some enterprises?

I am not the first one to say and lots of industry leaders and enterprise CIOs have been pointing it out that there might be cases where SAAS or Cloud Computing may not be right answer for some enterprises.

In a recent article at IT World Canada, titled “Why SAAS isn’t always the answer”, looks into one specific case, where Manitoba Insurace stayed away from SAAS model largely due to USA Patriot Act.

Yes for businesses in Canada or other countries, its very key to look into the legal aspects and security concerns before signing up with a US based SAAS or Cloud Computing vendor who only has a US data center.

Even for US businesses in the small to medium enterprise segment, from my recent discussion with a CEO, it was very clear, that “Security” is a key factor that may hinder businesses from adopting SAAS or cloud computing.

I am not rushing and concluding about the longer term viability of the business models of the SAAS or Cloud Computing vendors.  My inferences lead me to believe that both on-Demand (SAAS, Cloud etc.,) and on-Premise way of delivering software solution will continue to co-exist and the split between the two may vary on FAD of the month or the year.

If you have more time in your hand, this article at CIO.com is a worthy read

http://www.cio.com/article/477473/The_Case_Against_Cloud_Computing_Part_One

Healthcare a brewing crisis for a long time!

In most parts of the world one thing that’s common across the board for every country is that they always have a health care crisis.

My definition of crisis comes from Wikipedia’s definition of crisis and tend to take the meaning of “testing time”.

From the view, East or west, first world or third world,  almost all the countries are facing some sort of health care crisis and governments, businesses,  Not-for-profit organizations, individuals are all involved in working on a solution.

For example, to name a few crisis’ in brewing in coutries, here is a breif list.

• In America – 46 million(about 1/6th) of the population is uninsured, with the highest spending in health-care as % of GDP(see image) and poor adoption of IT in health care.

• In Canada (where I live), where its public health care, though most of the population thinks that we have the best health care the crisis is in supply of capacity and demand, efficiency of patient care, which results in a some unacceptable level of wait times for care

• In India, where I grew up, the crisis is totally different as Health Insurance is not prevalent, affordable health care for Indian population is an oxymoron, big gap in health care infrastructure and the list goes on

• In UK and other European nations, I would presume they are dealing with capacity and efficiency issues and its a learning curve that I have to take to understand more in detail on the health care crisis in Europe

In this blog I attempt to look at various solutions that are being proposed or worked at either by government, not-for-profit organizations or private enterprises towards continuous improvement in health care delivery across the world.

Stay tuned for more!

Thanks,