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eHealth 2008 conference

Speakers note challenges in computerizing health system

VANCOUVER – Front-line managers, along with national and regional planners, debated how much progress they’ve made on ‘extending the reach’ of the electronic health record at the annual eHealth conference and trade show, which was held this year over four days in May at Vancouver’s spectacular Convention and Exhibition Centre.

Some highlights from the keynotes:

• Dr. Lynn Nagle (pictured above), the former nurse turned PhD, presented her thoughts on what constitutes eHealth success and how to measure it. With clarity and a few concise slides, Nagle, now head of her own IT consulting firm, Nagle & Associates of Toronto, told of what she had learned both working with her clients and during a 25-year-career at Toronto’s Mount Sinai Hospital, where she rose to be vice president and CIO. She spoke first about what frustrates success the most.

“It’s the leadership issue. I think a lot of my colleagues still struggle enormously with getting the right level of sponsorship for their EHR projects within their organizations,” said Nagle unabashedly. “I think that work is seen by many as just IT work and therefore it does not need to engage senior people.”

• “Just five years ago there were some 17 electronic health record (EHR) projects on the go across Canada. Today there are over 260 EHR projects representing an investment of $1.5 billion on our part,” said Richard Alvarez, president and CEO of Canada Health Infoway, a major backer of the conference, in his opening remarks. “When you add in the matching money those projects attract, you’ve got a sizeable dollar sum that’s now making eHealth happen. We’ve started the job and we intend to finish it.”

Later in May, however, the Health Council of Canada issued a report asserting that Canada’s target of an electronic health record for 50 percent of the population by 2010 won’t be achieved, and that further funding for EHRs will be required to reach this plateau.

• Nonetheless, eHealth’s 2008 impressive numbers indicate that interest in EHRs is strong and growing. Shelagh Maloney, the outgoing head of COACH, Canada’s health informatics association and co-organizer of the conference, noted in her welcoming remarks how eHealth 2008’s attendance reflected the growth in coast-to-coast eHealth activity even over last year.

“1,692 – that’s the number registered as of this morning and that’s up 13 percent over the 1,399 we had in Quebec City last year, which was also a record,” said Maloney proudly at the opening plenary. “We have 153 exhibitors this year a 40 percent increase over last year and it was a sellout, with all our exhibitor space booked, which we really didn’t expect this year.

“We also received 351 abstracts and of those our program committee selected 115 for our concurrent sessions, again record numbers. We increased the number of tracks from the normal six to eight. We also added a virtual learning stream for physicians and another for executives.”

• Dr. Bill Crounse, the medical chief of Microsoft’s foray into eHealth, cited how the cellular phone is ‘leapfrogging’ other technology in extending the reach of healthcare – particularly to the rural poor in developing countries, where organized care traditionally extends not much beyond urban centres.

“In developing countries today it is not so much about laptops or desktops but about cell phones. We’re working on several scenarios at the moment, for instance, where receiving healthcare isn’t even dependent upon being literate. Instead we are using symbols on the cell phone screen,” said Dr. Crounse.

“So a parent can choose symbols for instance that shows the baby has a temperature, maybe is throwing up, and therefore needs guidance from a caregiver back at an urban centre.”

Now that Microsoft founder, Bill Gates, is devoting himself to his education and health foundation’s work, Dr. Crounse expects some rapid advancements in low-cost healthcare technology.

“One thing the Gates Foundation, for example, is very involved with is: How do we put a lab on a chip? How do we arm people in remote villages with simple technology that can do things like blood screening. We are putting a lot of investment into this kind of thing,” said Dr. Crounse. “Indeed in Jarkarta this week, Craig Mundy, our chief technology officer, is talking about scenarios where the cell phone itself becomes the diagnostic tool, perhaps through breath analysis.”

Meanwhile Microsoft has not forgotten the maddened thousands who wait too long for care back in developed countries. Dr. Crounse said the company sees great potential in self-service healthcare kiosks that promise to reduce wait times – following the lead of how the airline industry puts travellers to work arranging, booking, and ticketing their own flights.

Also, he spoke of how today’s new legions of ‘digital immigrants’ are using the health information resources of the internet to be as well informed as their caregivers, thus ringing the death knell of the paternalism that has long characterized doctor-dominated care.

Finally, Microsoft’s ventures into the storage and transmission of personal information – using a HealthVault beta database that’s available only to U.S. citizens at the moment – may popularize the EHR in a way current EHR proponents, such as our own federal government, had not envisioned.