Return from HIMSS

The Health Information and Management System Society (HIMSS) holds one of the best attended Health IT trade shows in the world. This year’s event was in Atlanta, Georgia, a beautiful and welcoming southern city. Atlanta is so welcoming that on Tuesday, during the Canadian Consulate Breakfast the city provided snow flurries, making all of us Canadians feel at home.

Come visit Us at HIMSS Booth 1407

There were several innovative Canadian companies at HIMSS, promoting the capabilities we have here in the Great White North. While the US health IT market is significantly different from what we have in Canada we can learn a great deal from the US, just as we can provide our Canadian experience and expertise to US companies and eHealth initiatives.

Not surprisingly the most popular topic at HIMSS is interoperability. The interoperability showcase highlights the need for system to system connectivity.

While the debate on health care reform continues the investment in Health IT is growing. More and more doctors are implementing EHR and EMRs. The ARRP and HITECH funding is making it possible for technology to be applied to the healthcare industry.

Hospitals, RHIOs, Clinics, Doctors and payer organizations are actively pursuing solutions to save money and improve healthcare delivery. Everything that is related to Health IT is needed. HIMSS provides the ideal trade show for these buyers to see the best there is to offer.

Next year’s HIMSS Trade Show will be in Orlando, Florida. A message for Orlando, as a Canadian coming to HIMSS in Florida in February, no need for snow.

Off to HIMSS in Atlanta

If its spring it must be HIMSS. This annual event gathers the world health IT experts together in one place for the preeminent health information management trade show. This year the host city is Atlanta, the jewel of the south, hot-lanta. I can’t wait to experience this city and all it has to offer.

Sav and Whale Shark in Galapagos

On Saturday, Feb 27th we arrive in Atlanta and begin our trip with a visit to the Georgia Aquarium, the largest in North America. Between 3:30 and 4 pm we experience the aquarium from the inside out. Scuba tanks go on for a swim with the Gentle Giants; Whale Sharks, the largest fish of the oceans. Don’t worry they don’t bite; they are filter feeders eating mainly plankton. This is a wonderful experience, if you can - watch for us on the Georgia Aquarium webcam. Or even better if you are in Atlanta come and see us at the Aquarium.

On Sunday, I’ll be presenting at the Health IT Venture Fair. While not officially part of HIMSS it takes please as a precursor to the show. Sponsored and organized by Blank-Rome of Philadelphia and Howard Burke this event showcases innovative companies that are seeking venture capital, partners and growth opportunities. Over 30 venture capital firms participate to get a jump start on the trade show exhibitors.

Sunday evening the Canadian Trade Commissionaires are hosting a dinner for Canadian companies to meet with US companies. This match making helps Canadian companies doing business or planning to do business in the US to find partnerships.

Come visit Us at HIMSS Booth 1407

The official HIMSS start is Monday, the exhibits open at 12:30 and until 5:30 we will be at Booth 1407, meeting with interested organizations looking for health IT solutions. Another HIMSS tradition is the Canadian reception that brings together all the Canadian exhibitors and Canadian attendees. This is always a rousing event with cross-Canadian representation and Canadian beer, BC and Atlantic salmon, perhaps even Alberta beef.

The Consulate General breakfast on Tuesday is another excellent networking and educational event. With trade commissionaires from across the US doing their best to promote the Canadian companies at HIMSS.

From 10:30 am to 5:30 we can be found on the exhibition floor at Booth 1407.

After the HIMSS reception on Tuesday night, it’s off to the Woodfire Grill an Atlanta hotspot for dinner prepared by award winning Top Chef Kevin Gillespie.

co-Owner and Executive Chef Kevin Gillespie

A relaxing evening is planned with BBQ ribs and friends to raise a glass.

That leaves the last day of HIMSS with the exhibit floor going from 10:30 to 5:30. In the evening a spirited HIMSS reception bringing us full circle as we return to our starting point at the Georgia Aquarium. Unfortunately, this time they wouldn’t let us go for a swim, I asked.

US Recovery and Health IT

Health Reform is a hot topic these days. The partisan nature of politics in the US hides the fact that we are all human. Regardless of if you are a Republican or Democrat, a conservative or liberal the concerns about sustainable healthcare are the same.

Last week I heard Dr. Blumenthal National Coordinator for Health Information Technology speak at the College of Physicians in Philidelphia. He talked about the growing need for electronic health records. His view is that electronic records are becoming the standard of practice. What does this mean to physcian liability? At some point the “average reasonable prudent person” standard will apply to medical records, and the liability of using paper charts will increase risk to physcian practice.

This week the Ontario Hospital Association invited Newt Gingrich and Michael Moore to speak in Toronto about health care issues. Two very different political views yet one very basic theme emerged. Invididuals are looking to the healthcare system to provide excellent care. Newt’s view is that the need for personal health records, better options and personal control with patient empowerment will do this. Michael Moore expects that without change the Medicare system in the US will fail, and what is needed is a universial goverment funded program. Are they both right?

The argument about health insurance avoids the overarching issue that is looming large on the horizon: the growing number of aging seniors; and the mounting costs that the healthcare system will encur. The only way to stem this flow is to switch from high-cost acute care to preventive care.

I believe that Health IT has an increasing role to play in this. Evidence based medicine means the use of information accumulated from health records can be used to improve care. Lower cost can be achieved by reducing emergency room visits and eliminating costly hospital interventions. We need drastic action to lower healthcare costs the use of electronic health records can contribute to radically improving healthcare.

H1N1 Vaccination

Since the time of Louis Pasteur there have been detractors of vaccines. Misinformation from seemingly reliable sources against vaccination has cost countless lives. Science is not often definitive and this ambiguity is used to raise doubt in some individuals predisposed to disbelieve.

Should you take the H1N1 vaccine? Many people who don’t get the annual flu shot are already saying they won’t. Otherwise normally intelligent parents who have failed to vaccinate their children will also avoid the H1N1 flu shot. We leave many such decisions to individuals, and for minors to their parents.

H1N1 Vaccine

I am not a medical professional and not qualified to make recommendations to anyone. I will follow my own conscience and listen to the counsel of who I believe to be trusted sources. Where each of us gets our information and how we use it is as unique as our own own decision making capabilities. What I know of H1N1 and the flu shot is limited, having seen people who have it or suspect the have it makes me concerned.

What has been reported is the older people born before 1950 are more likely to have antibodies that will help protect them from H1N1. The consensus of health professionals is that this virus is more likely to infect young adults. Women and more specifically pregnant women are most at risk of infection. The reported mortality rate of H1N1 varies from 1% to 4%; and while it is still young people who are at risk, children with preexisting conditions; diabetes and neurological conditions have higher mortality. Again consider that this high risk is both in the catching the virus and in mortality; once a person has the virus, as with any flu, how you deal with it and how your body reacts will determine the outcome.

My personal fear of H1N1 is how closely it seems to resemble the Spanish flu pandemic of 1918. This flu killed millions over several years. This virus mutated and became less viral over the years; it is likely one of the reasons why people born before 1950 have antibodies that may help fend off the current mutation; H1N1 previously called swine flu.

This week Ontario begins Flu shots for citizens. The US has been vaccinating people for several weeks now and has already seen shortages. I expect governments will do all they can to get vaccines for everyone who wants one. Individuals will have to make up their own minds on if they will get this years flu shot. I will.

Would you wear a bullet-proof vest as a policemen entering potential dangerous situation? Would you wear a gas mask as a firemen entering a smoking building? Wear gloves, put a hard hat on when entering a construction site? The flu shot, in my opinion is the same. If you are offered protect why would your refuse it? Of course the choice is your own.

Praise to the volunteers

This week the eHealth scandal in Ontario hit the press, $ 1 Billion spent to deliver electronic health records with little results. The Auditor General’s report on the eHealth initiative highlighted the cost of consultants hired, and the wasted opportunity to modernize the healthcare system. This same week our neighbor passed away, who volunteered for 48 years at the Etobicoke General Hospital. Consider the value of this selfless act against the actions of eHealth.

In my extensive experience in the health community of Ontario I’ve met many dedicated individuals seeking to improve health care. Nurses, doctors and regular people who directly impact health care. Volunteerism is very important in our health care systems both for fund-raising and in the delivery of care. These unpaid support staff in our hospital system save millions of dollars to the overall health care system.

Dorothy volunteered for 48 years, beginning with the fund raising efforts to build the local hospital; helping to get patients to their appointments and working in the gift shop. Her children were born in that hospital and in the end she passed away there. Last Friday the hospital honoured her work by flying the flag at half-mast. Even though a volunteer received no pay for their work, it is the most valuable gift that can be made.

Compare this with the millions of dollars taken out of the health care system by consultants working at eHealth Ontario. We all pay for our health care through taxes, so this is our money being spent. Even the consultants working at eHealth are tax payers, they should have been watchdogs of our money.

We can make a difference in health care. We need more dedicated professionals and individuals committed to helping improve the system.

Clarity Health Journal

Clarity Health Journal is a powerful communications tool that will improve the dialogue with your health-care providers, whether you’re managing a condition that requires continuous monitoring or even if you see your doctor only once a year.

Easy to Use; The Clarity Health Journal allows you to manage your care.

Easy to Learn; You can access links on relevant health information.

Easy to share; Allowing you grand access to doctors and other care providers.

Who is Clarity Health Journal for; This allows you and your family to take control of your health.

Clarity Health Journal

Security by Design for eHealth

How secure is your home, your car, your office? Do you use double bolt lock or have bars on your windows? How about internal alarms?

For the most part your answer to these questions depends on where you live and the value of your possessions. At the very least you have locks on your door, but you may leave the door unlocked from time to time. This is risky yet unlikely to result in major loss. If you do it too often and become lax in your home security then you give a thief opportunity that puts your possessions at risk.

Bank Vault

The level of security and privacy is dependent on the risk tolerance related to the value of what you are protecting and personal risk avoidance. When in comes to our personal health information the value of which is questionable, security can vary. Critical details about us and identifying information that can be used to obtain fraudulent documents or prescription must be treated with great care with the highest level of security. Our less personal details are not likely to be used to gain access to our money or take possession of our personal goods; these pieces of data are less important. While you may need the security of a “fort knox” to secure critical data, a simple key and lock is all that is need for other less critical details.

How do you secure data in your health information? Data that is stored must be encrypted with restricted access; when viewed it must only be displayed to a verifiable user with correct permission. Even with high-level security it is impossible to prevent a wandering eye on a screen. Early in our development of health information access the question of security and privacy always came up. Usually asked by doctors and nurses who raised this objection as a means to slow adoption. My quick response to questions on the security of electronic data was to point out that; currently fax machines in the hallway had patient data displayed, that behind the nurses station a white board with patient names and other identifying data was displayed for anyone visiting their unit; and that carts of patient charts are routinely rolled around the hospital and that these paper folders routinely would be left unattended. Electronic health information systems are much more secure than paper and non-electronic means. When records are electronic it means you can get access to your data much more easily than paper folders locked in a doctors cabinet or the basement of the hospital health records department.

Ideally we would want full control and access to all our own health information and be confident that it is not being misused or shared without consent. We currently don’t have that control. We rely on our doctors, our hospitals and other government agencies to maintain and control access to our health information. In the province of Ontario and many other jurisdictions individuals have the right to access and control permission to all their health information. Of course the practicality of receiving all this information from a hospital or doctors’ office makes it difficult. How would we get the paper forms and input them ourselves into our own health application? If records were electronic patient have better opportunity to access and control premission to their own information.

We need to ensure that proper percautions are being taken to store our information. To secure our health information the personal identifying data must be encrypted and only viewable by verified access. While user name and password is relatively simple, there are better ways to ensure privacy and security. A smartcard with proper token identification would be a strong method to secure access.

The NEXUS system is used by the US, Mexico and Canada for “trusted travelers”. The system issues a card for this program that uses several layers of security. First a person registers online and their user name and password is issued; then a face-to-face interview is conducted and documents verified (passport, driver’s license etc.); photo id is made and a retina scan is taken along with other details; then a card is issued with an RFID. When entering the country, rather then wait in a lineup, the “trusted traveler” uses the NEXUS card; unsheathed from the RFID blocking cover to access a self-help KIOSK. The traveler positions themselves in front of a device that takes a retina scan, which is compared to that on file, the proximity of the card is all that is required to match the individual to the online file. No swiping or entering of card number or pin is needed. The system verifies who you are by something you are carrying (the card) and your physical attribute; your retina scan. The process is quick and easy. The difficult part was in the verification and issuing of the card.

In Ontario the government issues an OHIP (Ontario Health Insurance Plan) card that is used for payment of services. Many individuals still have the old “red and white” card that is simply an embossed plastic card with only a 10-digit number on it.

OHIP Card

Individual refuse to part with this because the newer cards contain a “version code” and has an expiry date. Neither of these has embedded security, although the newer cards have a photo and a magnetic stripe that contains some personal identifying information that can be read by swipe machines. Other provinces and territories in Canada also issue health cards to citizens, due to our universal health care and the Canada Health Act a citizen could receive care in Ontario using their Alberta health card. Except for layout and check-digit calculation most systems in hospitals and clinics don’t verify health cards. It is unlikely that a fraudulent card would be detected or rejected until well after services have been provided. In the past it was known that some individuals would use the old “red and white” to obtain services for family members that were not eligible for OHIP, this type of abuse is minimal. Replacing all cards with a common standard and using smartcard token or RFID would be beneficial for all healthcare providers and consumers.

To create a secure and private electronic health application one could use the credit card and banking industry model. A credit card is issued from a specific institution, with the first grouping of numbers uniquely identifying the bank and card issuer, then there is a unique number associated with the individual. The card also has security features like check-digit algorithm, and security code. Other features like holograms, photos and smartcard and magnetic swipe all can be implemented on cards. The ability to add RFID would further enhance such an access verification tool.

Each card would be associated with an individual. Also with this model a card can have sub-accounts so that a parent can access records for child of other family member that has granted them access. This would be useful for better service traking. Take for example a child whose parent are divorced, each parent can have their child added to their card so that access to care is unencumbered when the child is with the other parent. This is also useful for family members such as elderly parents. The card has the ability to be a security key into an electronic health application. It isn’t the only consideration, it is a good start.

eHealth the future depends on it

The recent scandal with eHealth Ontario has derailed the progress of electronic health records for the citizens of Ontario. Yet, if you look at the progress to date, since 2004 when the SSH (Smart Systems for Health) agency was formed the project hasn’t been much on track anyway.

Estimates are that between $600-700 million has been spent on the provincial initiatives for electronic health care. What did this funding produce? How did we get to his stage?
The challenge with any large complex undertaking is to divide up the complexity into manageable and deliverable chunks. This makes it easier to tackle the big problems. If you look at the entire problem and build a detailed, comprehensive and complete solution the time and effort it takes will erode the proposed outcome. By the time the analysis and design is approved the environment will have changed, and before building the brilliant and complex product, the solution will be obsolete no longer meeting the current needs.

Even when such complex, complicated systems are built and deployed they become unyielding and unmanageable. They are difficult to maintain and keep current with the ever changing needs of the situation.

There is a large movement in healthcare the favours a monolithic solution, one system that does all. This comes from an antiquated philosophy and those the promote this concept are very much “old-school”. The executives raised on the mainframe or single vendor concepts.

I have been an IT consultant for over 25 years and my experience began with mainframes, although at the same time I used key-punch cards to do my programming for high-school was also when the original Apple, TSR-80 and Pet Computers were introduced. My career is firmly in both camps.

Over time I’ve developed complex systems for the financial sector, manufacturing and service industry; initially on IBM Mainframes, then DEC mini-computers and eventual PCs. In the 1990 my work also evolved into “pen-computing”, wireless and mobile devices. The systems are increasingly more integrated and networked.

In my long career I have personally never seen a “single-source” ONE system solution be fully successful. The monolith approach only works for a short period of time, until new requirements or changes to the business environment requires modifications. Because of accelerated demand on business the monolithic solutions is left behind. Why? Because the time required to change these monolithic systems is often surpassed by new systems and product add-ons. Creating and maintaining monolithic solutions lead to ultimate failings.

Even where one vendor, single source solution in implemented, within a short period work-arounds and new systems will be introduced. Still there are “old school” executives wishing for the ONE solution. They want something simple to deal with in what is actually very complex problem.

The internet is one solution built on the simple idea of allowing documents to be shared regardless of platform used. You can view the internet using a PC, a MAC, Linux, Unix or any other type of computer. Regardless of operating system (OS) as long as you can run a browser you can view the web. To share documents all you need is a text editor to build a simple html page.

It wasn’t until 1996 that I built my first web-page; it was to announce my wedding. Later that year I was involved in creating a web-based software store called instamall.com. The concept was to use encrypted transaction processing to allow users to buy software on the web. It wasn’t very successful but it did point the way to the future of the internet.

Since that time the internet has grown to being more then just sharing documents. Dynamic applications and content have revolutionized how we interact with technology. The growth and acceptance of social networking has effectively changed the world.

The internet is a very large complex system. Yet, its strength is its open standards and architecture that allows many developers to create solutions to problems and develop tools we didn’t even know we needed. Who would have thought Facebook, a simple university student gossip and communication site would have 200 million users in less the 5 years?

Twitter

What about Twitter an SMS message site that asked friends “What are you doing, now?” becoming a political force in the Iranian Election this year (2009)? By having open standards Facebook allowed developers to augment the site with new applications, effectively become a platform for new products that the Facebook staff could not have the time and resources to think about and develop themselves.

I’ve been using Twitter for 8 or 9 months now. Initially, it was novel using SMS to update my status. There wasn’t a lot of hype and only a few people followed my posts. Then suddenly hundreds began to link and follow my tweets. I now use Tweetdeck from my desktop and hootsuite to manage my accounts and Twitterberry on my Blackberry smartphone to send updates from where ever I am. Yet all these products were independently developed not by Twitter but independent developers using the open API provided by Twitter. Because of these a large adoption rate occurred in a short time. Because more the one company was building all the needs of the social users the adoption soared.

It is something to consider for eHealth solutions for a province like Ontario or the country of Canada or globally. Rather than build a monolithic ONE system to solve all the problems it is best to take a more modern approach. Use techniques common to the internet and social network sites; create an open platform to allow multiple developers to integrate and create innovative solutions to the problems of eHealth.

Another failing of ONE system approach is that each clinic, doctor, community and patient has different and unique needs. No matter how long and how detailed a single system envisaged it can never satisfy all the needs of all the users. The open architecture and open standards approach puts more people to work on the solution then could be every deployed and managed by ONE organization.

What is needed now is greater transparency and open specifications and standards can help accelerate the adoption and deployment of electronic healthcare.

Decision Support

We humans can learn a lot from other social networking animals like bees and ants. An article from The Economist issue from Feb. 14, 2009 discusses a study in Philosophical Transactions of the Royal Society by Dr. List talking about how honeybees decide on new nest sites. The article describes how groups make choices by consensus.

Queen Bee

When a bee hive splits the old queen leaves with 2/3rds of the workers, leaving her daughter at the old nest with 1/3 of the workers. Scouts are sent out to pick nest sites. Each scout returns and reports their findings. Then after new scouts review the best sites and report their findings a consensus is reached. This is not just about majority voters; consensus is reach on merits of the sites as reported and the validation of these observations by others. There is agreement reached between multiple scouts. If two scouts return with similar sites then additional scouts are dispatched to gather more details. Having different views with new observations gives the hive greater information upon which to base their decision.

In related research a look at how bad decisions are made shows that withholding information and sources with malevolent intent can create negative results. When the descison makers are isolated from information or are dominated by a another group the results can be devastating. The interdependence of communication is critical to decision making.

The concept that a group of individuals working collaboratively can arrive at a better decision than just one individual is central to our democracy. It’s why we don’t have dictators and why even our royalty is more ceremonial than functional. Our criminal system is based on group consensus when juries are established. More people mean more points of view and hopefully better information exchange to arrive at better decisions.

Yet, we humans also have our own faults; this is related to “groupthink“. Too often groups of followers get behind a dynamic or powerful leader and lose their way. Usually this leader is someone with a huge ego that doesn’t tolerate disagreement or criticism. What happens then is “blind following”, toeing the party line. There is a danger to this form of collaboration. Rather then a consensus this is at best an oligarchy and at worst a masked dictatorship.

A leader with minions is a weak leader. Without the challenging by equals and the review of options the end result doesn’t benefit from the social network strengths of our human race.

Back to bees and ants. When quick decisions are needed due to survival, the scouts sent out to find a new nest use fewer resources.

Worker Bee

The need to gather data quickly and train new scouts to identify and learn the route to the new nest becomes a critical function. If under threat, even the inexperienced became leaders. Of course this can not happen if all the followers are minions and none of the weak followers have been allowed to develop.

To Learn more about bees, check out thid wonderful site. http://www.carolinabees.com/about/bees/

Wealth is Health

This past week I attended a session titled “Health is Your Wealth”, a panel discussion about health promotion. Evidence has shown that the greatest determinate of health is wealth, so this topic interested me greatly. Wealthy individuals lead healthier and longer lives. So it makes sense that if you want to live longer and healthier you should seek wealth and be wealthy.

The question is how do we keep our society healthy? Perhaps the question needs to be; how do we ensure all citizens are wealthy? I believe we need to tackle poverty the same way we treat cancer and other chronic diseases. After all, we still don’t have a successful way to prevent these chronic diseases using medical interventions and procedures, why not use social methods? We could have better results in the long run.

More poor people are apt to get diabetes due to poor diet. Too much processed sugar, white bread and junk food is known to lead to pre-diabetic conditions and can make individuals obese and susceptible to type-2 diabetes. Healthy food costs more and therefore represents an inequity for lower income families trying to feed their children and stay healthy. To improve the diets of those susceptible to diabetes and prevent the future cost on the healthcare system you need to finance a healthy diet, provide better education and assist families to make healthy choices.

We must start early to improve the health outcomes of children and families. I come from an immigrant family. As children we knew more than our parents when it came to reading English and so our parents relied on us to read complex documents and contracts. Today many of the government materials are published in many languages which is better for new Canadians. Still it is the children of these new Canadians that are immersed in the new culture and need to be supported. With their new knowledge they can help with their parents’ immersion into the culture. Eliminating poverty could be the biggest health improvements of our diverse society.

Making wealth management and healthy living part of the educational curriculum and reducing poverty will benefit society with lower costs in the future. Families with the ability to pay for services that improve the health of their families who will be less of a burden later. This will eventually lower hospital costs due to mental health and chronic diseases. It is a matter of pay now or pay later. Except that pay later is a lot more costly.

Young people need to be taught the value of wealth and health to live a long and prosperous life. By starting early to educate and improve the perception of wealth and happiness we can improve our overall well being and create a healthy and wealthy society.