eHealth: Innovations and Issues

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eHealth Innovations and Issues

• Lecture 1
• Introduction
• History, Issues, and Developments in eHealth
• Norm Archer

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Agenda

• Class introductions
• Definitions of eHealth eHealth research
• History of eHealth
• Some healthcare statistics
• eHealth as an enabler
• eHealth networks
• Roles of electronic healthcare
• Some current hot topics in eHealth
• References
• Professional organizations

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What is eHealth?

• e-health is an emerging field in the intersection
  of medical informatics, public health and
  business, referring to health services and
  information delivered or enhanced through the
  Internet and related technologies. In a broader
  sense, the term characterizes not only a
  technical development, but also a state-of-mind,
  a way of thinking, an attitude, and a commitment
  for networked, global thinking, to improve health
  care locally, regionally, and worldwide by using
  information and communication technology
  (Eysenbach 2001)

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eHealth Dimensions

• 10 es of eHealth (Eysenbach 2001)
• Efficiency through cost reductions
• Enhancing quality of care
• Evidence-based interventions
• Empowerment of consumers and patients
• Encouragement of new relationships
• Education through on-line sources
• Enabling info exchange communication
• Extending the scope of health
• Ethics in patient physician interactions
• Equity in the provision of healthcare

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What is eHealth?...

• The application of Internet and other related
  technologies in the healthcare industry to
  improve the access, efficiency, effectiveness,
  and quality of clinical and business processes
  utilized by healthcare organizations,
  practitioners, patients, and consumers to improve
  the health status of patients. HIMSS News,Volume
  13 Number 7, p. 12.

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eHealth Dimensions (HIMSS)

• Innovations in
• Delivery of key information to healthcare
  partners
• Provision of health information delivery services
  
• Facilitation of interaction between providers and
  patients
• Facilitation of the integration of healthcare
  industry-related business processes
• Both local and remote access to healthcare
  information
• Support for employers and employees, payers and
  providers

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eHealth Research
Source What is eHealth (5)? (Jones et al 2005)
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eHealth Research

• Conclusions from (Jones et al, 2005)
• The scope of eHealth research (using,
  processing, sharing, controlling information)
  derived empirically from this study corresponds
  with textbook descriptions of informatics.
  Stakeholders would like eHealth research to
  include outcomes such as improved health or
  quality of life, but such research may be long
  term while changes in information technology are
  rapid. Longer-term research questions need to be
  concerned with human behavior and our use of
  information, rather than particular technologies.
  In some cases, modelling longer-term costs and
  benefits (in terms of health) may be desirable.

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History of eHealth

• The most remarkable feature about twenty-first
  century medicine is that we hold it together with
  nineteenth century paperwork. (Source Thompson
  2004)

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History

• 1960s technical uses of computers for
  biomedical and engineering purposes (e.g.
  calculating appropriate radiation dosages, etc.)
• 1970s applications in medical labs and
  hospitals for record keeping, and for medical
  research (using mini-computers and mainframes)
• 1980s advent of PC and communications networks
  widened scope of applications, with much
  experimentation in functions performed
• 1990s explosion of administrative applications
  and growth in clinical applications, primarily in
  hospitals and other institutions. Internet
  communications began to have a major impact on
  spread of knowledge about health among consumers.

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History

• 2000 the term eHealth came into use.
  Efforts began to develop EHR standards, and
  development of communication linkages among
  proprietary systems.
• 2005 significant efforts underway to develop
  common EHR standards, and overcome difficulties
  due to silos that have grown up over the years
  as legacy systems. Major difficulties due to
  differing levels of automation in communicating
  entities. Maintaining privacy and
  confidentiality has become an over-riding issue.
  
• Average spending on IT in health still far below
  other industries (e.g. Ontario hospitals spent
  2.2 of operating budgets on ICT (Information
  Communication Technologies) in 1997-2002.

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Last Year in Canada (Alvarez, 2005)

• 35 million Diagnostic Images
• 440 million Laboratory Tests
• 2.8 million Inpatient hospitalizations
• 382 million Prescriptions
• 3.4 million Vioxx Prescriptions in 2003 for
  patients that had to be contacted in 2004
• 322 million office-based physicians visits - 94
  resulting in handwritten paper records
• 60,000 physicians faced 1.8 million new medical
  papers in 20,000 journals and 300,000 clinical
  trials worldwide

2,000 transactions/minute require documentation
information flow
Information is the lifeblood of our healthcare
system
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Reality Behind the Headlines (Alvarez 2005)Lack
of Patient Data affects access, safety quality,
productivity

• For Every . . in Canada

• 75 people suffer an adverse event
• 90 suffer a serious problem with drugs received
  on discharge
• Up to 150 are unnecessary duplicates
• 300-400 are not screened
• 680 Specialists received no patient info
• 370-460 dont receive recommended Beta-blocker
  therapy

• 1000 hospital admissions
• 1000 patients discharged from hospital
• 1000 laboratory radiology tests       
• 1000 women at risk of cervical cancer
• 1000 patient visits with a Specialist 
• 1000 post-heart attack patients   

• In study of 168 traditional medical records 81
  did not have the information required to make
  patient care decisions
• CIHI estimates up to 24,000 deaths each year
  result from preventable adverse events in
  hospitals, in large part due to incomplete
  information

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Usage of the Canadian Healthcare System
(Anonymous, 2005)

• Every day in Canadas health care system
• 62,000 Canadians seek routine care (43 a minute)
• 31,000 Canadians seek health information or
  advice, and 23,000 Canadians seek immediate care
  for a minor problem (nearly 40 interactions a
  minute)
• Every day, the average physician provides 11
  medical, 3 surgical and 9 diagnostic services
  (875 services every minute)
• Nearly 7,800 Canadians are hospitalized, and
  remain there on average for more than 7 days
  (more than five admissions per minute)
• Each hospitalized patient may have ten
  interactions with hospital staff each day (350
  transactions a minute)
• 8,000 Canadians have day surgery (five surgeries
  a minute)
• Canadian pharmacists fill nearly 390,000 new
  prescriptions and around 515,000 refill
  prescriptions (more than 600 prescriptions filled
  a minute)

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Information Flows in Patient-Centred Healthcare
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eHealth as Enabler (CMA, 2002)

• An e-HEALTH system is an enabler for more
  integration, improved access, and better health
  care through better information management and
  use. E.g.
• Information exchange between providers on secure
  networks to enable providers to have timely
  access to critical information at the point of
  care
• Telehealth wait list management to help address
  access to health services
• Electronic health records , consolidated health
  information, and integrated decision support
  tools at point of care to reduce medical errors,
  improve health system efficiency
• Automated processes , wireless tools at the point
  of care, telehealth, and robotic surgery enable
  providers to allocate limited time
• Internet enabled consumer health information
  tools to empower consumers to interact with care
  providers in new ways and to manage their health
  more actively.

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Local Health Integration Networks in Ontario

• On November 24, 2005, the Ontario government
  introduced Local Health Integration Network
  (LHIN) legislation. This legislation authorizes
  and spells out the full mandate and
  responsibilities of Local Health Integration
  Networks (LHINs), that will set LHINs on a
  mission to plan and coordinate the province's 33
  billion health system from 14 regions, managed by
  individual Boards of Directors. Currently, there
  is little regional coordination among hospitals,
  long term care facilities, and the 44 Community
  Care Access Centres (CCACs).

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Regional Health Information Organization

• A Regional Health Information Organization (RHIO)
  is a multi-stakeholder organization that enables
  the exchange and use of health information, in a
  secure manner, for the purpose of promoting the
  improvement of health quality, safety and
  efficiency. In Ontario, LHINs, or Local Health
  Integration Networks, will need to be supported
  internally and linked externally to other LHINs
  by associated RHIOs. The Smart Systems for
  Health Agency (SSHA) is developing a provincial
  healthcare network to provide links among all
  healthcare institutions and providers in the
  province. It is developing and supporting
  standards for healthcare information and for the
  exchange of this information.

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Roles of Electronic Healthcare

• From (Bodenheimer, 2003)-Roles of electronic
  healthcare (EHC)
• Medical records
• Communication
• Knowledge base and decision support

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Perceived Barriers to EHC Adoption (Bodenheimer
2003)

• Takes too much time, for already over-burdened
  healthcare workers
• Too expensive, especially for small private
  practices
• Quality of consumer information on the Web is
  inadequate
• Software is proprietary, and systems wont
  communicate to one another
• Patient privacy issues
• Providers arent reimbursed for time and cost of
  adopting EHC
• Patient-physician relationships may suffer

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Evidence on EHC Effectiveness (Bodenheimer 2003)

• Prescribing
• Reminders for preventive and chronic care
• Physician feedback
• Patient self-management of chronic illness

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Current Hot Topics in eHealth

• HIMSS (Healthcare Information and Management
  Systems Society), sponsors studies on topics that
  are current and relevant to eHealthcare
• Integration and interoperability
• Ambulatory care
• Electronic health records
• Patient safety and quality outcomes
• Privacy and security
• Clinical decision support
• And many others

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Interoperability Integration

• HIMSS definition of interoperability is ability
  of health information systems to work together
  within and across organizational boundaries in
  order to advance the effective delivery of
  healthcare for individuals and communities.
  (HIMSS, 2005)

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Ambulatory Care

• Small physician offices
• Large group practices
• Outpatient departments (at hospitals)
• Walk-in clinics

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Electronic Health Record

• A longitudinal electronic record of patient
  health information generated by one or more
  encounters in any care delivery setting.
• Patient demographics, progress notes, problems,
  medications, vital signs, past medical history,
  immunizations, laboratory data, radiology
  reports.
• EHR can automate and streamline clinician's
  workflow.
• Can generate a complete record of a clinical
  patient encounter, as well as supporting other
  care-related activities directly or indirectly
  via interface - including evidence-based decision
  support, quality management, and outcomes
  reporting.

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EHR Advantages and Issues

• Source (Sprague 2004)
• Potential advantages
• Reduce errors
• Improve quality of care
• Improve efficiency
• Issues
• Implementation of standards, such as HL7, for
  interoperability
• Feasibility and cost
• Adoption and practice disruption
• Culture
• Technology making the wrong choice
• Legal barriers
• Data protection privacy, security, consent

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EHR, EMR, EPR

• Electronic Health Record (EHR) Used by a
  variety of healthcare providers A record that is
  available electronically to authorized health
  care providers and to the individual patient
  anywhere and anytime, in support of high-quality
  care. Intended to provide individuals with secure
  private lifetime record of key health history and
  care.
• Electronic Medical Record (EMR) Primarily used
  by physicians and office staff A record of
  periodic care, typically owned by a single
  provider organization, which captures and manages
  patient data. It is a complete patient record
  accessible from a single, automated health care
  provider system.
• Electronic Patient Record (EPR) Primarily used
  by nurses, pharmacists, and allied health
  professionals Electronic set of information
  about a single patient. An electronic patient
  record system is specifically designed to provide
  patient records electronically. Not necessarily
  restricted to a single clinical information
  system.

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Patient Safety Quality Outcomes

• Healthcare information systems should be
  instilled with optimized safety and quality
  improvement tools and are an integral part of
  regular operations for all healthcare
  organizations, clinicians, patients and community
  members.
• Reduced medical errors and adverse events,
• Improved healthcare quality,
• Better communication and education,
• Services more accessible, efficient,
  cost-effective.
• To achieve this requires targets, measurement,
  evaluation, and monitoring

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Privacy and Security

• All entities that use, send, or store health
  information should meet requirements for
  confidentiality, integrity, availability and
  accountability based on sound risk management
  practices, using recognized standards and
  protocols
• Privacy
• Security
• Legislation Personal Health Information
  Protection Act (PHIPA) in Ontario Federal
  Governments Personal Information Protection and
  Electronic Documents Act (PIPEDA)
• Patient consent

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Clinical Decision Support and Knowledge Management

• Clinical Decision Support (CDS)
• Providing clinicians or patients with clinical
  knowledge and patient-related information,
  intelligently filtered or presented at
  appropriate times, to enhance patient care. E.g.
• Simple facts and relationships to best practices
  for managing patients with specific disease
  states
• New medical knowledge from clinical research and
  other types of information
• Analysis of data collected from large sets of
  patients to monitor and improve the state of
  community health

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eHealth Professional Organizations

• HIMSS (Healthcare Information and Management
  Systems Society) at http//www.himss.org/ASP/index
  .asp
• COACH (Canadas Health Informatics Association)
  at http//www.coachorg.com/default.asp?id367

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References

• Alvarez, R. C. (2005). PHIPA presentation Taking
  the HI road to privacy. Retrieved December 28,
  2005, from http//www.governmentevents.ca/phipa200
  5/presentations/P2c.ppt
• Anonymous. (2005). User acceptance strategy (Page
  19). Retrieved December 28, 2005, from
  http//www.infoway-inforoute.ca/Admin/Upload/Dev/D
  ocument/EndUserAcceptance_CSAv10_2005MAY05.pdf
• Bodenheimer, T., Grumbach, K. (2003).
  Electronic technology A spark to revitalize
  primary care? Journal of the American Medical
  Association, 290(2), 259-264.
• CMA. (2002). Shaping a pan-Canadian e-health
  environment for physicians and patients.
  Retrieved December 28, 2005, from
  http//www.cma.ca/multimedia/staticcontent/html/n0
  /l2/hit/pdf/e-health-discussion-paper.pdf
• Eysenbach, G. (2001). What is e-health? Journal
  of Medical Internet Research, 3(2), e20.

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References

• Jones, R., et al. (2005). What is eHealth (5) A
  research agenda for eHealth through stakeholder
  consultation and policy context review. Journal
  of Medical Internet Research, 7(5), e54.
• HIMSS. (2005). Interoperability definition and
  background, from http//www.himss.org/content/file
  s/interoperability_definition_background_060905.pd
  f
• Sprague, L. (2004). Electronic health records
  How close? How far to go? Retrieved Dec. 29,
  2005, from http//www.nhpf.org/pdfs_ib/IB800_EHRs.
  pdf
• Thompson, Tommy G. (2004) - US Secretary of
  Health, quoted from remarks offered at the Health
  Information Technology Summit, Washington, D.C.,
  May 6, 2004.

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eHealth Innovations and Issues End Lecture
1Introduction to eHealthNorm Archer,
Ph.D.archer_at_mcmaster.cExt. 23944