11/13/2009. The Tsunami of EHRs!!! The DI-r Project. Healthcare Record Interoperability in the Context of Collaborative Learning

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1 Healthcare Record Interoperability in the Context of Collaborative Learning The Reality of the Emerging EHRs Technologies (Canada Health Infoway ) Sabah Mohammed and Jinan Fiaidhi Department of Computer Science Lakehead University CASCON Workshop on E-Health Interoperability and Smart Interactions in Healthcare, Toronto, November 5, 2009 The Canadian healthcare landscape abounds with pressures to address wait times, chronic disease management, aging at home, information and service integration, health human resource shortages, pandemic planning and most importantly health outcomes of individuals receiving care in our system. The Tsunami of EHRs!!! Mounting Investments!! NEODIN the Northern and Eastern Ontario Diagnostic Imaging Network (Image-Enabled Example) The $34.8 million project Diagnostic Imaging Repository or DI-r will enable electronic transfer of medical images and the associated doctors reports between hospitals in Northern and Eastern Ontario. Forty hospitals in the North West and North East Local Integration Networks (LHINs) and 19 hospitals in the Champlain LHIN (the greater Ottawa region) are involved in the project; Should be completed in 2011 The DI-r Project Having technology in place to quickly share diagnostic images amongst radiologists and physicians located far away reduces the need for travel, saves money and saves precious time, which is particularly vital in urgent situations, said Richard Alvarez, President and CEO, Canada Health Infoway. Repositories are essential to our goal of having the tools in place to instantly share the diagnostic images of Canadians with the specialists who need to see them, and is a core component of the electronic health records being built for every Canadian. 1

2 Federal Budget 2009 will assist Canada Health Infoway in implementing electronic health records. Funding of $500 million announced today is in addition to $400 million in support provided to Canada Health Infoway in Budget This brings the Government of Canada's total commitment to this initiative to $2.1 billion. Since its inception, Infoway and its provincial and territorial partners have made good progress in making electronic health records a reality in Canada. Across the country, increasing numbers of Canadians and health-care providers are gaining access to health information through secure electronic systems. Provincial Investment Of the $1 billion spent so far on the EHR initiative, $800 million was spent by the SSHA primarily to build a computer network for health care providers that is expensive to operate and significantly under utilized, mainly because of a dearth of available applications. Specifically, it is costing $72 million annually to operate the network; and, on average, users are utilizing less than 1% of the network s available bandwidth (or system capacity), with peak usage averaging only about 16% of available bandwidth. Greater Incentives Required for EHRs Large Scale Adoption When asked about problems that resulted from adoption, focus group participants mentioned that the most significant issues seemed to revolve around the conversion of paper records to electronic format. There seems to be a general consensus that this transition process was the most difficult obstacle in EHRs adoption. Encouraging a policy of paying for transition support project management and practice management services. This has helped accelerate uptake of EHR in Alberta. In Ontario, physicians are not able to use their EHR subsidy funding for project management and practice management services. This policy prevents physicians from gaining the full value of their investment. As a result, many EHR implementations fail, leading to poor uptake by other physicians who see their colleagues struggling. For example, the failure rate of EHRs in the Hamilton area is approximately 35%. This has effectively halted EHR implementations in the area as physicians are waiting to see whether their colleagues can turn their practices around. EHRs Software from Good Vendor Markham, Ontario June 10, 2008 Today, Nightingale Informatix Corporation ( Nightingale ), an application service provider (ASP) of electronic medical record (EHR) software and related services, announced that it will implement its web-based Nightingale. Or From MediTech EHRs System costs only $850!!! Whether you are a general practitioner or a consultant, and work solo or as a small group, you will find UniCharts electronic medical records system sufficient for your clinical documentation and workflow needs. It is being successfully used in a wide range of medical specialties including Primary Care, Neurology, Psychiatry, Cardiology, Pulmonology, Urology, Physical Medicine & Rehab and Pain Management. Incorporating the best of client-server and browser technologies, it is one of the most advanced EMR software in terms of functionality and user interface design. And starting at just $850 for a 4-User lifetime license, it is probably the only low-priced emr software that provides its users the customization capabilities of high-end electronic medical record systems. Easy to learn, Easy to use, Easy to install, Easy to customize, Easy to maintain, Easy to rely on, Easy on the budget, 2

3 EHRs Software from Wal-Mart Open-Source EHRs Software CHITS ClearHealth FreeMedForms GNUmed FFEHR HealthForge Indivo OpenEMR OpenEHR OpenVista OSCAR McMaster TORCH VistA ZEPRS KEY 2 LIFE E-EHR By inserting the Key 2 Life EHR into a computer USB port, your medical records are instantly displayed for medical personnel during emergencies.the E-EMR - emergency electronic medical record can be updated at anytime by you or your physician. KEY 2 LIFE E-HER Contents Who You Are Your Allergies Your Medications Current Medical Conditions Your Blood Type They Can View Your Radiology Images CT Scan - MRI - ECG - X-Ray Your Immunization Record Your Lab Reports Your Cardiac History Your Wound Care History Medical Implants If Any Previous Medical Procedures Previous Hospitalization Record Your Advance Directives Such As Living Will - Medical Power Of Attorney Authorization For Care To A Minor(s) Do Not Resuscitate Order (DNR) Emergency Contacts Doctor Contact Information And Much More Choosing the right EHRs System!!! Purchase the Right EMR Software!!! How to Purchase the Right EMR Software for Your Practice September 18, 2009 by Jake Linkowski l Planning: l EMR ROI: l EMR Vendor Selection: l RFP: Request for Proposal: l Electronic Medical Record Support: l Final considerations: 3

4 Bypass for Solving the EHRs Bottleneck!!!! Interoperability: EHRs Evolution Major Obstacle For technology to be useful, systems need to connect with other systems. The premise and the promise of the Internet are based on connectivity. Without connections to hospitals, laboratories and other health care organizations, physicians don t realize the full potential value of their investments. We have to introduce basic standards in order for the following communications to be effective in the Medical Community. a. For EHR to EHR communication b. For hospital to EHR communications c. For Laboratory to EHR communications d. For medical device to EHR communications e. For EHR to Physician/Healthcare user communication Interoperability Formal Roadmap Archetypes Interpretation Virtual EHRs: The Mile One Step!!! President Barack Obama, along with Defense Secretary Robert M. Gates and Veterans Affairs Secretary Eric Shinseki, announced April 9, 2009 that VA and the Defence Department have taken steps toward creating a joint virtual lifetime electronic record, or VLER. "VLER will serve as a model for a nation, especially at this tumultuous time of health care reform, and is intended to be a lifetime, personal record for use by the service members, their families and service providers to ensure a seamless continuum of care and benefits," Enabling Technologies for Data Sharing? In cyberworlds as well as in real world healthcare environments there is a need to enable EHRs sharing and cooperative communication without taking care of the cultural differences between EHR systems and types!!! 4

5 Possible Solution!!!! The idea is to design pluggable agents to support cross-cultural EHRs sharing and communication for virtual communities in distributed environments. Open Source Technology for Sharing EHRs Open Source Software has been extremely successful in various technology sectors but has been slow to grow in the healthcare industry. However, OSS serves a vital role by breeding innovation at a break neck pace. But which one: Is it OSCAR OSCAR may now be the EMR in Ontario with the 2nd largest market share, when measured by the actual number of physicians using an EMR. May be OpenEHR, but wait.. It is an open standards medical data structures and features that provide not only standard interoperability solution, but flexibility as well in constructing data layer in EMR/EHR. It contains Maximum Set of Globally Common Clinical Concept as Archetype Data Set. Common medical/health parameters and tags are set to global standards. - Built on Java Technology 5

6 Possible Architecture Supporting EHRs Cross-Culture Sharing and Communication Possible Architecture EHRs Data layer: this layer consists of a set of autonomous, distributed data sources. Each data source makes its own decision about the system and data, and great heterogeneities may exist among different sources. OSGi layer: this layer hides the heterogeneities exposed in the data layer, and presents an uniform view (i.e. services) of all resources to the upper layer. All resources are exposed as Grid services except data resources which are exposed as Data Access Services. P2P and Social Networking layer: this layer organizes services using P2P and Social Networking Publish Subscribe models for the support of decentralized service discovery and schema mediation. Application layer: this layer performs some data intensive operations utilizing the latest Rich Internet Application (RIA) technology. Questions... 6