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Ehealth in the news – EHRs profiled in Canadian Business magazine March 16, 2006

Posted by Hans in : analysis, news , 2comments

I came across an interesting little article in a recent issue of Canadian Business magazine (Feb. 13-26, 2006) written by Erin Pooley titled, “Health’s digital divide: Electronic health records”. The article caught my eye because it was included in a special theme issue on media and the forthcoming digital transformation. Medicine/health was one of the sectors that is to be transformed by new media technologies. The article itself focused on developing an electronic health record with profiles of Canadian companies and interviews with people like Richard Alvarez (CEO of Canada Health Infoway) and Sam Marafioti (CIO of Sunnybrook & Womens Health Science Centre). I found the article interesting not for the information provided (no “new” information is reported), but because ehealth was profiled as an important issue – independently of health care. Yes, health care is the 800 pound gorilla of public spending in Canada, but the figures that reported were interesting.

Before I forget, I just love this quotation from Sam about why developing an electronic health record (regional or national) is difficult:

You can’t walk up to the health ATM, stick your tongue in it and get a health check. The ATMs have been pretty successful at showing how somebody can get their balance anywhere in the world and draw money. Health doesn’t work as simply as that.

Way to go Sam! Here are some interesting figures:
- Public health care spending in 2005 (projected): $98.8 billion up from $74.7 in 2001

- Cost to build a pan-Canadian EHR: $23 billion over 10 year

- Estimated savings from EHR: $6 billion annually

The value of this article, in my opinion, is not for the information. This article is important because it presents one important infrastructure issue in easy to understand language to a general (if business-oriented) audience. Maybe if the Canadian corporate world realizes that there is money to be made and saved in health care – maybe, just maybe – we might find more resources or at the very least more attention to the issues at hand.

Some thoughts about the article:

- It’s interesting that the author lists adoption as the most important issue in getting the electronic health record up and running.

- Alberta gets favourable coverage as being a leader in Canada. I’m always fascinated that while is hailed as a leader (let’s face it – they’ve done some good work), no-one examines the population and diversity of Alberta as a potential problem when trying to implement Alberta’s solution. From some high-level meetings I’ve attended, Alberta representatives have made some presentations but are surprised at the complexity and size of Ontario (Ontario can be considered as five Alberta-areas). Also, I heard another high-level Alberta official mention how the Alberta situation is unique – they’ve had one government in power for almost two decades I think (Ralph Klein has been around forever).

- Finally – how come no-mention about evaluation? How do we know we’ll realize any of the purported benefits? Are we to trust the vendors? But, that’s just me being the researcher (and this specific question being my research topic).

You can read the full article online at:http://www.canadianbusiness.com/technology/companies/article.jsp?content=20060213_74576_74576

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Lessons Learned from Canada’s 2006 Federal Election March 13, 2006

Posted by Hans in : news, opinion , add a comment

In Canada, we recently held an election at the Federal level (January 23rd, 2006). The election was called in late 2005 when the Liberal minority government fell. On election day, Canadians voted and received a Conservative minority government. While the overall result was not surprising, some of the details were (and continue to be) quite interesting:
- Continued polarization and regionalization of voters;
- Decreased support for the Bloc Quebecois (separatist party) in Quebec;
- Increased support for the NDP;
- No Conservative seats won in the major metropolitan areas (Toronto, Vancouver, Montreal), but strong support in rural ridings.

Okay, so what does this have to do with health or with ehealth? Based on these results, I think there are lessons that can be learned. Remember that health care (in Canada at least) is a socio-political creation. As such, health care often reflects the (changing) values and priorities of the general population. In my opinion, to ignore the election results would be somewhat short-sighted. So, here are the lessons:

1. One-size does not fit all
Not that two minority governments indicates a “trend”, but I’m not convinced that majority governments are the default position any longer. I actually think that minority governments will be the norm in the future, particularly if we look to some of the results and trends in Europe. In Canada (and in other parts of the world), we see a splintering/polarization of interests that is reflected in the voting patterns of different regions and areas. We seem to have a form of entrenched regionalism in Canada, and this situation is not likely to go away any time soon.

In the ehealth world, the parallel would be to try and create a single system that meets everyone’s needs. Given the regional differences and interests, a single solution is probably difficult and unlikely to succeed. I heard a presentation by Holly Witteman on a similar topic that has some interesting similarity (scroll down to the middle). Sure, Holly was talking about the individual level, but I think the concept can be applied successfully to the macro-level where the provinces (or regions) are the individuals that have needs for customization.

This idea that one-size doesn’t fit all brings me to my next observation and lesson.

2. Cooperation, consensus, and collaboration
Well, in a minority government cooperation, consensus, and collaboration is the name of the game. To get anything done, minority governments must compromise to get everyone’s support. Maybe it’s time health care starts to do the same (at all levels). That probably means that each group must recognize that we are all in this together and are only part of the solution – not the entire solution.

3. Urban/Rural divide
As mentioned in the introduction, the Conservative party was very strong in the rural ridings, but failed to win any in the major metropolitan areas. Does this sound at all familiar to health care? Basically, we see significant differences between the needs of urban and rural areas. Not only are the areas culturally different, but they are different in terms of the specific needs and pressures.

Maybe it’s time that we, as a group of researchers, developers, and managers, take a good look at addressing this division between the cities and rural communities. Last year, I wondered what role ehealth could play in addressing some of the rural needs. More needs to be done. The election results in Canada (and in the US) seem to point out that life, culture, needs, and thinking in the cities is vastly different from the rural areas. Unless we want to see a further fracturing of society and even health care services, we need to address this division. For rural health organizations, some have difficulty maintaining safe and clean buildings to house patients. Developing an ehealth infrastructure is not a priority when you have difficulty meeting the basic needs.

4. Find the best solution not the easiest
I’ve heard that minority governments often are the most effective forms of government because the needs of more people are met because of process involved (compromise, collaboration, and consensus) to get a bill passed. In a similar vein, I think that in health care, we need to focus on developing and implementing the best solutions – not the easiest. In all honesty, I’m not sure what “best” looks like or how to get it. But, I know that the easiest solution usually isn’t the right one. To use a political example, it’s easy to say that the solution to the economic problems we face in Canada is to “cut taxes” – is that necessarily the best or the right one? Or, in order to address wait times, we need to offer more “private” options. Again, it’s easier to offer private options, but is that the best one or the right one, especially when considering lesson #5 (see below)?

5. Build for the future
Finally, unlike most political groups that focus on short-term results (i.e., get elected again), we need to focus on building strategies and solutions that will meet today’s needs without sacrificing the future. As my supervisor Alex Jadad often says in his presentations (paraphrase) – we need to build the health care system that meets our children’s needs and expectations not ours. A recent article in the Globe and Mail by Stephanie Nolan titled “Millenium Man” (Saturday, March 11, 2006, Page F4 – sorry, there’s no free electronic version) profiled Professor Jeffrey Sachs. Sachs argues that the reason why Africa is in such dire straits is because they sacrifice the resources they have to meet the bare necessities to survive, thus leaving no resources to build a future. Are we doing this in health care, here in Canada?

For more information about the 2006 Federal Election, you can visit either the Wikipedia entry on the Canadian Federal Election 2006 or the official results from Elections Canada (Elections Canada doesn’t seem to have a dedicated area for the 2006 election just yet. I think they leave the most recent election results on the main page until a new election is called).

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Blanket WiFi access in Toronto March 9, 2006

Posted by Hans in : analysis, news , add a comment

This week, Toronto Hydro Telecom announced plans to create a high-speed wireless zone beginning in the downtown core. Touted as being a means of bringing “Toronto on to the world stage”, the service will be free for the first six months. A few colleagues have suggested that this development may be a significant step toward unleashing ehealth in the Toronto area.

While providing access to the Internet via a highspeed wireless network is a significant advancement, much work still needs to be done:

1. Secure Wireless Access
In order to meet the privacy regulations, we need to provide a secure means of transmitting data. As far as I know, public access points to the Internet is not “secured” – meaning that you “use at your own risk”. With all of the hype and paranoia surrounding confidentiality and privacy, don’t we need to find some sort of means of providing secure transmission? I’d say that this is the first step that needs to be addressed. Without it, no institution or provider is likely to use this new network.

2. Development of Systems
Much like the early days of the Internet when there was too little content, applications need to be developed to give patients and providers a reason to use and “connect” via the system. Sure we can access the web, but what will we use it for? As with the Internet in general, content rules.

3. Bridging the Socio-economic Divide
Even though much work needs to be done, we still need to make low-cost access available to all – it’s an issue that does not get much press. I’m going to assume that once the six-month trial period is over, access will cost anywhere between $25-$50 a month. Sure, that doesn’t seem like much, but for those people who have limited financial means, that’s $300-$600 a year that could be spent on food or clothing. Is the Internet worth more than food, clothing, or housing? If we truly want to get *everyone* to use this new infrastructure, even the most disadvantaged must have access too. Should this service be offered freely? If Philidelphia is debating the issue of providing the service for free (or for a significantly lowered cost) – why can’t Toronto?

This announcement to develop a highspeed wireless zone in downtown Toronto is a good starting point. But, we also need to address the needs of those not living in the urban core: the suburban population as well as those living in rural communities.

High-speed wireless access to the Internet anywhere in the downtown core, while a great first step, is not a solution. We need to do more.

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Do we need a health care version of the olympics? March 6, 2006

Posted by Hans in : opinion , add a comment

I’ve often wondered why people (and society in general) can get so worked up and passionate about certain events, and yet remain absolutely untouched by others. Previously, I noted the zeal and passion that some people have for computer products – the same concept applies to fans of music bands or car aficionados and so forth. Why is it that there isn’t the same fervor for saving people’s lives? The crisis in Africa barely even registers in the media or to the average person’s consciousness.

Then, just this past month, the 2006 Winter Olympics were held in Torino, Italy. As an aside, I must admit some degree of national pride at how well the Canadian athletes (particularly the women) performed. I was amazed at how easily I could get engrossed in events like bobsleigh, cross-country skiing, or even skeleton. Other than at the Olympics, I don’t even think about these events, and yet, every four years or so, I find myself glued to the TV to see how Canadian athletes fare.

Maybe it’s time we need a health care Olympics.

I’m not suggesting that health care professionals “compete” with one another, but rather hold a world-wide event every four years to celebrate the progress that countries have made. This event could highlight advances in the basic medical sciences, primary care, public health, and even ehealth. I know that different societies hold annual events, but maybe that’s too often to capture the attention and imagination of the general/lay public.

Is it out of our mind to push our governments, industries, and population to compete to improve upon past achievements? Each country could work to establish areas of global excellence and then enter in friendly competition to see who has made the most progress in four years time – or who has the most elegant solution to problems. Building upon the national pride of countries, this type of event might be a catalyst for people to start thinking of health care in terms of “systems development” rather than providing care for a particular individual or a particular cause.

Not to forget those less fortunate, these health care Olympics could also be the time when countries take stock of how well we (as a global community) are handling poverty, famine, AIDS, and other global threats. The (athletic) Olympics, in my opinion, is a celebration of what people can achieve when they are inspired to perform in athletic competitions. Maybe health care needs to find some inspiration to go “faster, stronger, and higher”. The stories we hear are those of children being inspired by athletes to take-up sports and compete for their country. Why can’t we do the same, but in a health care domain?

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