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Google Health PHR is being retired after all

June 27, 2011 6 comments

An official Google Blog post on 24 June announced that  Google Health will be retired in January 2012 as it has not resulted in the broad impact anticipated at its launch three years ago.  Patients will be able to download their data through January 1, 2013. Google Health’s no-cost, secure, online, open source, patient health record made available to health consumers, was expected to improve health care by enabling patients to be partners in the management of their health.

Most health records worldwide are still paper-based, and those in electronic format may be scattered among hospitals, doctor offices and specialists. Technology standards and data ownership issues are yet not clearly defined, so populating personal health record with data can be an onerous task.  Adoption of personal health records involves a fairly steep learning curve and a change in cultural mindset.   Finally, the cost of housing data and creating applications to make the data useable and secure is high.  Though disappointing, it is perhaps not surprising, therefore, that Google has pulled out of the personal health record space.

In Canada, Telus Health Space has moved into personal health record provision, building on the Microsoft Health Vault platform,  partnering with hospitals, health care associations, and academic research initiatives to standardize technologies and encourage development of applications to make PHRs more useful and user-friendly.  Telus Health Space is not free, however; it  is only available to users for a fee, which might make it a more sustainable business model.

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Availability of new e-Health Implementation Toolkit (e-HIT)

November 1, 2010 Leave a comment

The e-Health Implementation Toolkit is the product of the two-year research project, funded by the Service Delivery and Organization (SDO) stream of the National Institute for Health Research in the U.K, to identify the barriers and facilitators to implementation of e-health initiatives within the National Health Service. The e-HIT is intended to act as a sensitising tool – to help senior managers in their thinking and planning for an e-Health implementation in considering potential problems that will likely be faced and to help facilitate thinking about how they can be overcome or avoided.

The toolkit is downloadable from http://www.ucl.ac.uk/pcph/research/ehealth/documents/e-HIT.xls. It covers consideration of Context (including organisational factors, national and local policies, and other drivers of the implementation); Intervention (the impact on professional – patient interactions, inter-professional relationships, and the effectiveness and cost-effectiveness of the intervention); and Workforce (the impact of the intervention on workload, workflow, distribution of work between different user groups, the need for education and training, and the impact on relationships between professional groups). Reports are generated based on responses to items listed within the toolkit.

The development and formative evaluation of the e-Health Implemention toolkit is described in a paper, published in BMC Medical Informatics and Decision Making 2010, 10:61, available at: http://www.biomedcentral.com/content/pdf/1472-6947-10-61.pdf.

The what, why and how of implementing Personal Healh Record Systems

September 14, 2010 Leave a comment

Electronic health record (EHR) systems have greatly improved efficiency and safety in health care delivery: consolidating patient information, tracking prescription use, and enabling decision support.  These systems are controlled by the healthcare providers, some of whom can and do make patient information available to them electronically or via specially requested printed reports.  Patient health record (PHR) systems, introduced in the last couple of years, are a new development, allowing patients improved ability to access their health record at any time outside the care setting, and to even control information and access to that information.  While there are obvious concerns about privacy, control, and legitimacy, the attraction of PHRs to providers and policy makers is the ability to engage patients in their care and, in doing so, to improve care as well as control costs.

The PHR market is still very immature, but there are a number of approaches and developments already underway internationally, with vendors offering a range of possibilities.  Two reports may be useful to those considering the why, what and how of implementing a PHR system:

A 2008 report: The Value of Personal Health Records, by the Center for Information Technology Leadership (CITL), synthesized the best-available evidence and expert opinion into a simulation model of costs and benefits in different PHR scenarios to develop the value proposition of a PHR system.

CITL considered two primary components in a PHR system: infrastructure and applications utilizing the infrastructure. The PHR infrastructure included components and functions that would allow patients to collect and share their health information. Privacy and security functionality are expected to be embedded throughout the PHR system in both infrastructure and applications. The CITL model estimated costs to develop the PHR infrastructure; and the applications to support:

  • information sharing (medication history and test results);
  • information self-management (remote monitoring, web-based educational support); and
  • information exchange (medication renewals, appointment scheduling, e-visits).

Although the model has only been validated by a consensus review process among domain experts and so may differ dramatically from what will actually be experienced, CITI hopes that this will provide a framework for analysis and that extrapolation from the model can facilitate predictions of potential value to those considering employment of PHRs.

A more recent report by Alberta Health Services: Engaging the patient in healthcare: an overview of Personal Health Record Systems and Implications for Alberta, presents a very through and useful overview of PHRs, evaluation of PHR capabilities, a comparison of vendors and benefits and caveats of PHR systems.

There are three distinct categories of PHRs, differentiated by their underlying IT architectures:

  • Stand alone: For example, WebMD and RevolutionHealth: that offer an external user interface and data repository, allow patients to create profiles based on their medical history,  health-tracking that can identify patient risk factors for a range of diseases,  and enable users to connect directly with one another , but they don’t automatically interact with EHRs.
  • Tethered: Offered by large healthcare IT vendors that are predominantly focused on EMR/EHR solutions, for example: Eclipsys Sunrise, Epic Systems MyChart, Cerner Health Connections, and McKesson HorizonWP, who offer a PHR system as an extension of the provider’s health information system, allowing patients to view their personal information through a patient portal. These modules can include tools that enhance patient-provider interaction (e.g., e-scheduling, e-visits, pharmacy requests), disease/health management (via dashboards), and financial services. They offer limited decision-support and social networking capabilities, but most vendors are partnering with services such as GoogleHealth and Microsoft HealthVault to broaden the range of services and make patient data portable beyond the provider’s internal systems. Recently, Telus acquired an application by Sunnybrook Health Sciences Centre in Toronto: MYchart that enables patient access to health records, messaging to providers and clinicians, and limited health-management trackers. However, it apparently offers little ability to scale and interact with multiple systems.
  • Interconnected: Google Health, Dossia, Microsoft Health Vault, and Telus HealthSpace (in Canada) are the major players in this market, which is just getting started.  The  interconnected PHR.combines elements of stand-alone and tethered PHR systems, providing an external repository of health information that users can control and to which health systems can connect. The PHR functions as the user interface for a broad set of IT functions that can be linked to or built into the PHR through the vendor’s development tools. These systems can also collect data from multiple repositories across multiple settings or health systems. Telus HealthSpace is a licensed version of Microsofl HealthVault, but data is stored in Canada. Also, while most major players currently in the interconnected PHR systems market offer their solutions for free, Telus will charge health systems to build onto HealthSpace.

Apparently an interconnected PHR need not necessarily replace a tethered PHR, but be used in addition, to provide the user interface and access point for patients, with the tethered PHR system providing the connection with other IT capabilities (e.g., secure physician email). The most successful PHRs implemented at large health systems today have taken this approach (e.g., Kaiser Permanente, Cleveland Clinic, Beth Israel Deaconess Medical Center).

This white paper is the result of a two-week investigation, which included interviews with McKinsey experts in global healthcare and IT, and an expansive literature review, and analysis of industry and market research.  As the report points out, there are over 200 vendors in the fledgling, but rapidly growing PHR market, so there is a high degree of variability in both the nature and scope of product offerings.  This value of this report, therefore, is in understanding what is available, what is possible, and how to make the choice between alternative systems.

New eHealth Platform has potential to allow Canadians manage their own healthcare.

June 3, 2010 1 comment

On May 31, 2010, British Columbia based Telus Corporation announced launch of a new consumer ehealth service, TELUS health space, powered by Microsoft’s HealthVault. This will allow Canadians access to their personal health record (PHR) files on the internet or on mobile devices, potentially empowering individuals to be better involved in the management of their health.

The concept of Web-based patient controlled health records is relatively new. Microsoft launched HealthVault in 2007, Google launched its platform, Google Health in 2008.  These PHR services (or patient-controlled health record (PCHR) as they are also called) were originally marketed directly to consumers. However, an article in Health Data Management Magazine observed a change in strategy– these services are now being offered in partnership with hospitals and emerging health record banks. Partnerships are also being aggressively sought with medical device manufacturers to establish connectivity to various medical devices for home health monitoring, as well with hospital infrastructures to increase capability for data integration and disease management services.

Apparently, this is the first consumer health platform in Canada to achieve Canada Health Infoway  pre-implementation certification for providing a secure, interoperable application environment and personal information health platform, and it is also the first international deployment of HealthVault.  Telus Corp. is Canada’s third-largest wireless carrier. It is creating an online medical database with Microsoft Corp. to expand its telecommunication services to the health-care industry. While it has faced flagging revenues due to competition in the mobile phone industry, its health-care business is expanding by more than 10% a year and the unit is profitable, according to an article in Businessweek. Telus expects to license its PHR software to healthcare organizations, including provincial governments, health authorities, hospitals, insurers, individual practitioners and employers.

Patient controlled health records have the potential to revolutionize healthcare, but there are some challenges to overcome.  Privacy regulation compliance, data integrity assurance, interoperability of devices etc. are technological challenges that are being addressed.  However, the full potential of PHRs to revolutionize the healthcare system will only be realized when providers are adequately persuaded of the benefit of sharing data, and patients and providers have access to the education and the tools they need to effectively work with the system.

EHR Impact Study Findings: Interoperability, long-term strategic focus, good management essential to realize eventual benefit from investment

Findings from the recently released EHR Impact study: The Socio-Economic Impact of Interoperable Electronic Health Record (EHR) and Eprescribing Systems in Europe and Beyond, show that EHRs and ePrescribing are not quick wins, but they are sustainable wins. An important finding was that interoperability is a prime driver of benefits from EHR and ePrescribing systems, as benefits rely on access to information regardless of place and time. Local, closed ICT systems lacking interoperability would not release these substantial gains. Extremely important to success of such investments, also, is the skill and expertise of executives and managers in managing organisational change and resource redeployment.

The study comprised nine quantitative and two qualitative independent evaluations of selected case studies (listed below). Two perspectives were applied: the socio-economic, and a narrower, financial one within the socio-economic to enable estimation of the long-term impacts of interoperable EHR and eprescribing systems. Calculations involved some 1300 time series variables and about 600 estimates and assumptions that do not change over time.

Cost levels depend on the scope of the EHR and ePrescribing solution, the range of healthcare levels affected, the type of health system, and the economic environment of the investment. Per estimates, it can take at least four and, more typically, up to nine years before initiatives produce their first positive annual socio-economic returns, and six to eleven years to realise a cumulative net benefit. A key finding of the study was that benefits from EHR and ePrescribing investments come under very broad, diverse categories, but are very individual and specific to the respective context of an investment.

In the sub-analysis of financial impacts, study findings show extensive reliance on executives’ and managers’ skill and expertise in organisational change and resource redeployment to realise financial returns. However, engagement must be continuous, not just consultative: both management and professionals need to constructively address issues that arise regarding positions, propositions, concerns and requirements on an ongoing basis. Achievement of specific goals requires a consistent, continuous investment in people as well as technology over a long time period.

Perhaps not surprising, the report finds there is no single, theoretically right strategy for implementing interoperable EHRs and ePrescribing systems. It is advisable that decisions to invest in EHR and ePrescribing systems devise and adopt strategies that fit their local or regional setting and are designed to succeed by meeting clearly identified, measurable needs.

By taking the socio-economic perspective, it was estimated that initiatives can achieve returns of close to 200% on their total investment, and an average of about 80% over some nine years. Financial gains can be up to 60% of the total socio-economic benefits, with an average of some 13%.  Financial outlay can be between 20% and 85% of the total socio-economic cost of investment, and an average of about 50%. The match of extra cash for the initiative and extra cash generated is usually a negative bottom line, with exceptions proving the rule. When opportunities to redeploy resources liberated by efficiency gains are included, the financial gains increase to an average 60% of total benefits, exceeding the extra cash invested.

The case studies upon which this evaluation is based are:

  • The Emergency Care Summary of NHS Scotland, UK
  • The Computerised Patient Record System at the University Hospitals of the Canton of Geneva, Switzerland
  • The Hospital Information System at the National Heart Hospital Sofia, Bulgaria
  • The regional EHR and ePrescribing system Diraya in Andalucía, Spain
  • The regional ePrescribing system Receta XXI in Andalucía, Spain
  • The regional integrated EHR and ePrescribing across Kronoberg County, Sweden
  • The Kolín-Čáslav health data and exchange network, Czech Republic
  • Dossier Patient Partagé Réparti (DPPR) – Shared and Distributed Patient Record platform in the Rhône-Alpes Region, France
  • The regional Healthcare Information System in Lombardy, Italy
  • A nation-wide health information network in Israel – qualitative report
  • Evanston Hospital, Northwestern Healthcare, USA – qualitative report

The study was commissioned by the European Union DG Information Society and Media.

New Guide on Implementing Electronic Medical Record (or Electronic Health Record) Systems.

March 31, 2010 1 comment

Investments in electronic medical record (EMR) systems are on the increase worldwide, fuelled by the promise of cost savings, improved workflow, potential for drug discovery through collaborative and multi-disciplinary cross-disease research, and improved patient care.  Implementation of EMRs is a complicated process, encompassing numerous challenges: cost, existing infrastructure, multiple products, vendors and applications, scalability needs, legal requirements and user buy-in.  Impartial guidance on implementation of EMR systems seems hard to locate, which may account for the fact that close to 50% of implementations fail, causing significant financial losses and other organizational and personal anguish (Keshavjee, 2006).

In Ontario, Canada, hospitals have developed at least nine different internal EMR systems, and scores of subsystems that have been developed in labs, pharmacies and clinics.  Ontario physicians use at least 20 difference electronic records systems – many of which are incompatible, because of commercial competition between system vendors (CMAJ, Mar, 2010). This makes the goal of integrated care and other potential benefits of EMR extremely elusive.

Today I came upon one of the best guides on implementation of the Electronic Medical Record (EMR) I have seen yet. It is entitled:  Electronic Medical Record Implementation Guide: The Link to a Better Future, 2nd Edition, and is downloadable in pdf format.  The document is produced by the Texas Medical Association and published by The Physicians Foundation.  Three continuing medical education (CME) credits in ethics and/or professional responsibility education are available for the material in this book (effective Sept 2009 to Sept 2012). Although this book covers many issues pertinent to implementation of the EMR in the United States – (i.e. discussion of the American Recovery and Reinvestment Act [ARRA]), this is an excellent resource for all physicians, practice managers and administrators considering adoption of an electronic medical record system  anywhere in the world.  It offers guidance on conducting needs assessments, vendor contract issues, open source software, legal considerations for utilizing technology and steps for selecting, implementing and maintaining an EMR system.