Melissa Memorial staff gets high marks in state surveys

By April Peregoy

Melissa Memorial Hospital was the subject of three surveys that took place during the month of September. Reporting at the East Phillips County Hospital Board meeting Tuesday, Sept. 23, administrator John Ayoub was happy to announce the hospital performed very well on all three surveys.
The first was a state survey conducted to make sure the hospital was meeting all the conditions of participation. Ayoub said the survey went well, and he gave staff members a lot of credit for their hard work and cooperation.
Only three minor deficiencies were found, all of which had to do with administration and paperwork areas and not with healthcare procedures.
The first revolved around conflicting policies caused by outdated paperwork that had not yet been upgraded. Ayoub said the hospital is working on bringing all their policies up-to-date. The hospital was also told the Chief of Staff needs to sign off on each department policy.
MMH was also marked down for not currently having an outreach site for pharmaceuticals. This is due to the recent cancelation of the hospital board's contract with Banner Health. The situation is only temporary however, as the board is working on finalizing a contract with Poudre Valley Hospital of Fort Collins to provide telepharmacy services.
Ayoub also pointed out MMH is not the only hospital in this situation, as five other hospitals in northeast Colorado are affected as well.
A follow-up Life Safety Survey was also conducted over the past month. This survey is more facility-focused and is done to make sure all emergency equipment such as emergency doors, fire alarms and fire extinguishers are working properly.
The survey was actually conducted in February and a number of things were found that needed to be corrected. Checking back in to make sure MMH had followed up on these corrections, the September survey found the problems had been fixed.
The final survey was the State Vaccine For Children Survey, which was conducted in the Family Practice Clinic. It is done to make sure the clinic is performing and storing vaccinations properly. Again, Ayoub reported the clinic performed well on the survey.

Staff transitioning to new
electronic record system
The hospital is now beginning the process of switching to an electronic medical records system. According to Ayoub, the first phase of the transition began on Oct. 1 and involves the implementation of practice management software.
After a 90-day training cycle with the new software, the hospital will transition into the electronic record system in early 2009.
Ayoub said the system will greatly benefit patients because their medical charts can be accessed right away. It will also allow the hospital to do its own billing rather than rely on another company to do it for them.
In August, a new documentation form was implemented to help the staff transition into the new system. Chief of staff Dr. Dennis Jelden told the board Tuesday night the new forms have been a big help and the staff is adjusting well to them.
Another computer system purchase request the board is considering is for a claim scrubber. This is a computer application that detects errors made in a claim before it is sent to an insurance company. The purpose is to reduce claim denials due to technical mistakes.
Ayoub said the application could cost as much as $30,000, but would benefit the hospital in the end by improving the efficiency of the payment process with the insurance companies.

Special meeting scheduled
EPCHD will hold a special meeting Tuesday, Oct. 7 to discuss and approve changes recently made to its Ends Statement. The board felt the policy was too important to make a quick decision on it, and wanted some time for review.
A public hearing on the hospital board's budget for 2009 will take place at its next regular meeting, which is scheduled for Tuesday, Oct. 28.

Other business
In other business Sept. 23, the EPCHD board:
-toured the laboratory and heard a general report from lab director Deb Taytum on the department's services and staff.
-was informed Tuesday night Dr. Scott J. Hadley, who treats patients needing emergency dental care, will no longer be available to the hospital. The board is now searching for another dentist in the area to provide this service.
-approved a lease with Harry Sprague to farm the 20-acre empty lot behind the hospital. Ayoub said this was done to save time and money on mowing and to be respectful of the surrounding neighborhood.
-reaffirmed the hospital's policy that EMS attention will be given to all calls that come in, regardless of whether the emergency site is located within district boundaries.
-was informed the hospital had its first on-site helicoptor landing. Ayoub stated some complications did occur, but that it was a good learning experience and next time the staff will be even better prepared.
-canceled its contract with the company that provides the hospital with its Spanish-language phone line. A new contract has already been signed with a different company.
-signed a contract to upgrade and improve the hospital's website. Once the initial upgrades have been made, Ayoub said it is his desire to have a staff member trained to maintain the website.
-was notified the hospital received a $9,000 SHIP grant. MMH is also seeking an emergency preparedness grant.
-heard a presentation from the MMH Foundation that the board is expected to close on a loan in October for the donor recognition wall and MMH history wall.
-approved a bid from EIDE Bailey to provide the hospital's auditing services.
-heard a report from FBLA member Samantha Redfern on the progress being made on the clock tower project. The report showed the club still has $17,000 to raise for the project.
-held a 30-minute executive session to discuss the sale of the old building.

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UnitedHealth Group/Pacificare Awards More Than $6 Million in Grants to Help Improve Health Care in California

CYPRESS, Calif. (Jan. 17, 2008) – As part of its ongoing commitment to California, UnitedHealth Group (NYSE: UNH) and PacifiCare have awarded more than $6 million in grants to benefit health care consumers and improve the delivery of health care services in the Golden State. The grants, ranging from $100,000 to $740,000, have been awarded to 15 California nonprofits dedicated to improving health care services through enhanced health care technology opportunities, and driving preventive health and coordinated care initiatives.

“UnitedHealth Group and PacifiCare are committed to investing in a healthier California,” said David Hansen, CEO, Pacific Region of UnitedHealthcare. “We do this by offering products and services that address affordability, access and quality needs for all Californians, and also through grants to community health organizations that will help improve the health care delivery system for everyone, including underserved populations.”

The grants announced today include:

• $360,000 to the Ukiah-based Alliance for Rural Community Health to implement electronic health records in six federally qualified health centers in Mendocino County;
• $100,000 to Centro La Familia Advocacy Services Inc. in Fresno to expand community health outreach activities related to healthful eating and lifestyles via its Promotora program;
• $350,000 to Orange-based Children’s Health Initiative of Orange County to implement a Web-based application and tracking system for children’s health programs and other state-sponsored services;
• $367,250 to Darin M. Camarena Health Centers Inc. in Madera to purchase computer equipment that will enhance clinical information management, billing and organizational service growth;
• $664,688 to Glendale Adventist Medical Center to help implement a rural telepharmacy project that will enable rural hospitals and clinics to better comply with pharmacy standards, improve quality and reduce medication errors;
• $187,000 to Willows-based Glenn Medical Center to purchase new equipment to allow digital recording and transmission of diagnostic studies, which will help improve speed and efficiency of rural patient care;
• $360,000 to the Institute for Healthcare Advancement in La Habra to support implementation of electronic medical record (EMR) and practice management systems in a pediatric community clinic serving Los Angeles and Orange counties;
• $593,720 to the Northridge Hospital Foundation to enhance and expand its school-based obesity- and diabetes-prevention program;
• $740,000 to Planned Parenthood Mar Monte/Fresno to establish a response center serving a 27-county area using IP Telephony;
• $361,684 to Ukiah-based Redwood MedNet to establish an information network allowing clinics and hospitals in Mendocino, Lake and Northern Sonoma counties to share patient and medical information;
• $500,000 to Ridgecrest Regional Hospital to expand telehealth and telemedicine capabilities to additional rural care providers;
• $200,000 to Shasta Community Health Center in Redding to complete the implementation of its EMR system;
• $159,155 to Fremont-based Tri City Health Center to upgrade its telephone system and improve its ability to serve its low income, ethnically diverse patient population;
• $705,184 to the Vista Community Clinic to purchase and implement its EMR system;
• $731,070 to the University of California San Diego Department of Emergency Medicine to develop the San Diego Safety Net Health Information Exchange, an integrated information system between community clinics and hospitals.

The grants are part of a $25 million commitment to California by UnitedHealth Group and PacifiCare. The grants and their identified uses are well-aligned with UnitedHealth Group/PacifiCare’s historic and ongoing commitment to improve the health care delivery system across California.

Recently, UnitedHealth Group committed $10 million to University of California Riverside and University of California Merced for the creation of medical and health science education programs at the two campuses, and for hiring of administrative, teaching and support staff needed to establish course work and classes for the programs.

Today’s grants represent the first phase of proposal applications, which were received in fall 2007. The second phase began Jan. 2 and will end Feb. 18. Copies of the Request for Proposal, which includes complete instructions and information on qualifications, are available online at www.pacificare.com and www.unitedhealthcare.com.

UnitedHealth Group offers health benefits, including commercial and Medicare health plans to nearly 2.5 million Californians and partners with about 50,000 physicians across the state.

About UnitedHealth Group
UnitedHealth Group is a diversified health and well-being company dedicated to making health care work better. Headquartered in Minneapolis, Minn., UnitedHealth Group offers a broad spectrum of products and services through seven operating businesses: UnitedHealthcare, Ovations, AmeriChoice, Uniprise, OptumHealth, Ingenix, and Prescription Solutions. Through its family of businesses, UnitedHealth Group serves approximately 70 million individuals nationwide.

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Medical imaging goes filmless

The days of doctors posting X-ray images on lighted white boards are over at Hilton Head Regional Medical Center.

Instead of shuffling through envelopes full of negatives and using magnifying glasses to search for problems, doctors and radiologists now can view the images on powerful computers with screen resolutions higher than the human eye can process.

With a click of the mouse, physicians can magnify images to pinpoint tiny abnormalities in image scans -- a feature not available with printouts. What's more, those physicians can do it all from their personal practices or even in their homes.

As of this week, doctors will access MRIs, X-rays, ultrasounds and CAT scans through the hospital's new $2 million picture archiving and communication systems, also known as PACS.

Photo: Dr. Robert Clodfelter demonstrates the magnification capabilities of the new PACS system Monday in an emergency room office at the Hilton Head Regional Medical Center. Kristin Goode | The Island Packet

Photo: Radiology technicians Tiffany Schweitzer, left, and Victoria Riddle ask Eric Miller, PACS administrator, a question Monday at the medical center. Kristin Goode | The Island Packet

Physicians said saving time is the most important benefit of the electronic system.

In the past, technicians would have to take the films, develop them and deliver them to the radiology department for doctors to view. That could take as long as two days.

Now, as soon as the images are shot, they're uploaded directly to a high-speed transmission line and loaded onto doctors' computers. The entire process can take less than an hour.

"Waiting," said Dr. Robert Hewes, a radiologist, "is the worst thing we go through. Patients want answers. We want to be able to provide them as fast as we can."

Dr. Robert Clodfelter, medical director of the Emergency Department, said having the images available electronically aids in diagnosis, saves valuable time in emergencies and allows doctors to consult with radiologists off site in real-time.

Through a secure, online system, images can be accessed remotely from any computer with Internet access.

A radiologist "can be at home on his personal computer and look at the exact same image I'm looking at," Clodfelter said. "There's really no comparison to the old white-board way. ... It's a good time to be practicing medicine."

It's part of Hilton Head Regional's move toward an entirely electronic patient data system, which began last year when all paper was removed from the Emergency Department.

Within the last 18 months, medical records, the pharmacy system and some patient files were moved to the electronic system. In time, charts for inpatients will be paperless as well, said hospital CEO Elizabeth Lamkin.

"This is one of a series of things we're doing to take the hospital into the Information Age," she said.

The PACS system is fairly common among South Carolina hospitals, said Patti Smoake, a spokeswoman with the state hospital association.

Coastal Carolina Medical Center in Hardeeville has been using an older version of the computerized systems for a couple of years.

Within a year, Tenet, the parent company of Coastal Carolina and Hilton Head Regional, will upgrade that system so physicians have remote access to the images.

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IT Solutions Can Improve an ASC’s Bottom Line

Case Study #1:

Preventing Errors and Waste

In the operating room (OR), clear communication is supremely important. Extensive time is spent gathering patient information, and ensuring all the appropriate preparations are made. But, miscommunications and mistakes still occur resulting in potential medical mishaps and lost revenues. Within the confines of OR suites, full utilization of information technology (IT) can help prevent such errors and waste. Numerous people, operating on countless systems, are responsible for gathering all the necessary data, and a system that creates centralized storage for medical information can prevent technology gaps that plague many hospitals.

Judy Swanson, RN, joined Texas Children’s Hospital as director of perioperative services in February 2001, and discovered that the department’s existing perioperative information system was full of holes. Texas Children’s Hospital in Houston, located in the Texas Medical Center, is a 697-bed licensed, internationally recognized pediatric hospital, and is the largest children’s hospital in the U.S. The Texas Children’s surgical staff operates 24 hours a day in three different sites, treating patients ranging from newborns to adults. Managing all of the department’s vital data in order to maintain the hospital’s high-standard of safety and keep costs in check is a great challenge. Swanson, who has managed ORs like Texas Children’s for more than 19 years, led the implementation of department-wide automation technology to meet and exceed this challenge.

The Challenge

For years the department had been collecting information in several different applications that required a significant amount of manual data entry and failed to provide comprehensive reports. Surgeon preference cards were stored in Microsoft Word, and could not be tracked or organized in a significant way. Intraoperative nursing documentation and inventory control were done by hand, often with unreadable handwriting. Nurses documented surgical cases and calculated OR charges manually, resulting in numerous clerical errors. Bits and pieces of information were scattered across a group of disconnected systems, and each staff member used a personal method for documenting procedures. The lack of an agreed upon nomenclature and a central location for patient and billing information contributed to an inefficient workflow and inaccurate data. The information the system did gather could not be effectively analyzed, because the system did not generate statistical reports.

Additionally, the department’s unproductive system of data capture resulted in missing or erroneous information in approximately 40 percent of patient records. The billing department returned all errors to the OR for correction. This forced nurses to waste valuable time trying to track down correct information and caused numerous reimbursement problems. The department averaged more than $100,000 per month in late charges, and the staff time lost to manual documentation and backtracking was priceless.

The department was in desperate need of a comprehensive system that would institute an agreed upon language for all procedures being documented, and provide a single, central location for all information, from patient record details to billing codes. After initial research, it was decided that an upgrade to an all-inclusive OR management system would improve the hospital’s clinical documentation and make good sense for the hospital’s bottom line. The hospital launched a wide-ranging search for software that would document all phases of surgical care, from scheduling to preoperative care, through the OR and on to recovery, critical care and billing. Additionally, the system needed to provide a complete electronic record of the surgical event that enabled easy data access to promote patient safety, and allowed for analysis of this data to ensure the best allocation of time and resources.

A Singular Solution

In 2001, after an extensive assessment of all viable software systems on the market, the hospital team selected CareSuite OR Manager, a total perioperative automation solution from Picis, a Wakefield, Mass.-based company that specializes in high-acuity-care automation technology. The hospital chose this system because they felt it met its diverse clinical and administrative needs. OR data management and electronic record keeping from preoperative care through surgery to recovery, were all available as part of the system. Also, it easily interfaced with the hospital’s IDX admissions system and allowed for a multitude of ways for staff to capture and report statistical data without requiring manual entry.

After selecting OR Manager, Swanson and the department staff set out to fully implement the system. An implementation team was established and they examined, in detail, the functionality of the system and then streamlined organizational processes to maximize use of its capabilities. The team standardized surgeon preference cards and implemented online nursing documentation in the system to provide a complete electronic patient record of surgery, thereby erasing the need for the time consuming, often inaccurate, manual methods previously employed. Additionally, they adopted routine accounting principles in the department and focused on getting charges right before transmitting to billing. This included development of accurate and well-tested billing rules in OR Manager that automatically calculate perioperative charges based upon time, procedures, supplies and other factors. The entire staff, from clinicians to accountants, was now speaking the same language, and the focus shifted to accuracy and correctness during input, thereby greatly reducing the need for reconciliation.

Results

Texas Children’s Hospital went live with the Picis system in September 2002, and nurses began scheduling cases in OR Manager while tracking supplies and recording exceptions online. The data was then transmitted directly to the hospital’s billing system. Charge capture was improved, and lost time was decreased. Due to increased accuracy, online documentation and data analysis, Texas Children’s was then able to manage an increased number of surgical cases and meet the goal to drop the bill promptly.

Now, dependable and accurate reports allow staff members to continually see what is working and to fix what is not. With reports from OR Manager, the evaluation of staff performance, overall costs, use of supplies and other activities in the department is substantially simplified. All such reports were unavailable with the department’s old surgical information system. Reports also track staff members having clinical documentation issues, and log quality information.

Supply utilization and procedure times of individual surgeons can also be reviewed to improve the accuracy and management of schedules and supplies. By introducing a physician office link, they were able to decentralize scheduling and allow surgeons to schedule cases at their convenience into their block time. Physicians enjoy the increased flexibility, and remote scheduling has saved Texas Children’s Hospital the equivalent of two full-time positions while enabling an increase in the volume of cases. The schedule is more accurate with the offices doing their own scheduling. Additionally, the offices now can provide insurance information through the system directly to the admissions department. This has resulted in fewer delays for insurance hold.

Sweeping change across a department is never easy, and implementation of a new automation technology is no exception. But, it was worth the hard work, and hospital administrators see the effects, so they are happy. Before implementing the Picis system, it took Texas Children at least five days to process the correct patient bill. Now, the hospital captures accurate clinical, financial and statistical data during each phase of surgical care, and within 12 to 24 hours of surgical care the process is complete.

Now, less than 2 percent of OR charges contain errors. Within four months of go-live, the hospital recognized significant benefits of using the system: faster billing; an 80 percent reduction in monthly late fees; a department-wide language for documentation; and centralized data storage and reporting tools for easy access to meaningful reports. The result has been enhanced resource planning, which has physicians and staff praising the system.

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Case Study #2:

Achieving a Complete Patient Experience

In March 2007, SourceMedical, a provider of information management solutions to the ambulatory surgery center (ASC), surgical hospital, practice, rehabilitation clinic and diagnostic imaging markets, announced a strategic partnership with InstyMeds. The union establishes SourceMedical as the exclusive provider of the SourcePlus PrescriptionCenter, a fully automated, ATMstyle dispensing system for outpatient prescription medication services to ASCs and surgical hospitals. The complete outpatient prescription medication system is ideal for facilities who want to provide to patients fast, accurate dispensing every time, with the added benefit of safety and the convenience of receiving full prescription medication at the point of discharge. The system provides facilities a “complete patient experience” and differentiates them in the market and allows patients to return to the comfort of their home as quickly as possible. It will also support underserved communities that lack 24/7 pharmacy availability.

Today’s surgical facilities are always looking for distinct advantages over the competition while providing patients with compelling benefits never before seen at the point-of-care. The SourcePlus PrescriptionCenter acts as a new profit center — increasing revenue while reducing medication errors and supporting patient convenience.

Waseca Medical Center, located in Waseca, Minn. and part of Mayo Health System, has become one of the first healthcare providers in the region to offer a unique service that gives patients the option to have their prescriptions filled 24-hours a day, seven days a week. This service targets not only same-day surgery, urgent care and emergency room patients, but is available to all patients.

“Our patients have told us they want to be able to fill their new prescriptions around the clock,” says Michael Milbrath, executive vice president of Waseca Medical Center. “This new system gives our patients access to a pharmacy that never closes. They may no longer have to drive somewhere else to have their prescriptions filled, especially after hours.”

Getting a prescription through SourcePlus PrescriptionCenter works much like getting a prescription through a pharmacy. The patient’s insurance information is gathered and entered into the computer during the admission process.

The healthcare provider enters a prescription and gives the patient a prescription order number. At the SourcePlus PrescriptionCenter dispenser, located near the emergency room at Waseca Medical Center, an automated touch screen walks the user through the ordering process. The patient enters the prescription number and their birth date for verification.

The patient then enters a credit card, debit card or cash to cover the cost of the prescription or co-pay. The medication is automatically labeled and a comprehensive bar code check system ensures that the patient gets the correct medication. In most cases the medication is dispensed in less than five minutes.

“Although many of the most common prescriptions can be filed, not every medication is available from the InstyMeds (SourcePlus PrescriptionCenter) machine,” says Kim Rux, pharmacy director at Waseca Medical Center. “The machine will also carry some over-the-counter medications. InstyMeds (SourcePlus PrescriptionCenter) was added with our patients in mind. They are charged the standard retail price without any added fees or charges.”

A telephone located near the dispenser provides a direct line to a support center staffed by pharmacists and pharmacy technicians 24-hours a day, seven days a week. This is especially helpful for patients who may have questions about their medications, including when they should be taken, how they should be stored and possible side effects, if any.

“With the nationwide shortage of pharmacists, this is one way Waseca Medical Center can truly meet the needs of our patients,” says Milbrath. “We believe this is a good step toward reducing the amount of time patients have to wait to get their prescriptions filled, as well as reducing the number of medication errors.”

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Case Study #3:

PNDS, Electronic Medical Record Systems and Data

The Perioperative Nursing Data Set (PNDS) is an American Nurses Association (ANA)-recognized nursing vocabulary developed by the Association of periOperative Registered Nurses (AORN) to describe nursing care for patients undergoing a surgical or other invasive procedure from preadmission to discharge. As a controlled vocabulary, PNDS enables nursing care to be documented in a standardized manner. This will allow for collection of reliable and valid clinical data on perioperative nurse sensitive outcomes resulting from nursing interventions during a surgical or invasive procedure. PNDS is applicable in various perioperative practice settings including both inpatient and ambulatory surgery environments. Standardized documentation allows nurses to evaluate care across caregivers and practice settings.

While PNDS can be used in both paper and electronic documentation, the real advantage comes when it is implemented in the electronic health record (EHR). The manner in which data is documented, captured and mined is a critical factor for improving healthcare. PNDS is designed for the EHR as it contains the framework of uniquely coded clinical terms and knowledge that describe patient care provided during a surgical or invasive procedure regardless of the setting.

Using standardized nomenclature such as PNDS in electronic documentation provides the vehicle for gathering and aggregating data for analysis. The impact of using and mining the PNDS data is on several levels:

• The immediate impact is for the clinical perioperative nurse in terms of enhanced communication and the linkage to clinical support
• Healthcare organizations benefit from effective standardized outcome reporting and quality improvement activities
• PNDS provides reliable and valid clinical data that can be used by researchers to uncover new clinical relationships

Electronic Medical Record Systems

As described above, the electronic medical record is much more than just the replacement of your paper charts. Early attempts at solving the problem of storage space and access gave way to a misconception that simply scanning paper records or moving your paper forms to electronic copies of those forms was an electronic medical record. What advantage would one of those formats have over a paper record in making the use of PNDS any more practical or efficient? The answer is, none whatsoever because the image of an electronically stored document is still just an image and not useable data.

If a facility has decided to standardize the terminology and nursing diagnosis information contained in the PNDS, an EMR is the most efficient way to implement the system. Before selecting an EMR you must ensure that the required functionality is present and that the developer of the EMR has acquired the proper licensing from AORN.

Functionality is a key to the efficient use by the nursing staff. A few of the major points to look for are:

• Does the EMR contain all the required structured data elements (SDAs)?
• Can you obtain the detailed explanations of the SDAs easily?
• Can you easily access information on interventions and recommended activities?
• Does the EMR allow for recording of nursing diagnosis codes?
• Are there standard reports in the EMR for reporting on outcomes and nursing diagnosis codes?

Some of the benefits resulting from integrating PNDS with an EMR are as follows:

• Nursing as a profession benefits from documentation of outcomes and comparisons to procedures completed with a reduced amount of nurse participation.
• The integration of PNDS into an EMR will permit the measurement of nursing full-time employees (FTEs) involved in a procedure directly to a CPT code. This will further support their value in a clinical setting.
• Direct access to PNDS within the EMR (the recommended practice) will help support real-time nursing decisions.
• Facilities will be able to provide more detailed outcome studies with less cost. Comparative studies using paper charts could take as much as one, possibly two additional FTEs.
• Patient safety is a top priority among any healthcare organization. This type of solution would help determine if the correct steps were followed should a negative outcome occur. It provides risk mitigation without sacrificing productivity.
• Submission of outcomes data supported by PNDS to AORN’s national database will assist in enhancing and supporting changing or modifying practices on a national level.
• Electronic access to intervention and recommended activities improves actual utilization and reduces FTE’s when compared to information stored in paper or book format.
• Electronic maintain of nursing diagnoses and other information allows for a more current data set than a once-a-year hardcopy update.

Your unique needs may require other components and functionality to be examined in making your decision on which EMR will best suit your needs. Keep in mind that moving from paper to a true EMR will change your work flow and some duties for your staff. However, you want to look at the full scope of what changes and what you gain in making your decision.

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Canadian e-health sector could use a booster shot

We don't have a trusted local brand, the size of the market is small and there's still a lot of cultural resistance. We check the vital signs of what should be a burgeoning industry

There's a host of opportunities for Canadian companies looking to serve the burgeoning electronic health record market, but insiders say serving the market is not going to be easy.

A number of hospitals have already set up electronic record systems with patient information, and a national agency, Canada Health Infoway, has a mandate to create a unified e-health record by 2009. Despite this momentum, as well as the handful of programs to help fund the automation of doctors' offices in Canada, however, resistance to the idea still runs high.

“The real challenge in health care is cultural,” said Ross Armstrong, senior research analyst at London, Ont.-based Info-Tech. Persuading doctors to invest thousands of dollars of their own money in a system that will benefit the health care system as a whole and change the way they work is a huge challenge.

To encourage doctor buy-in, vendors, he said, need to better craft their messages to show doctors how digitizing their offices will give them more time to dedicate to the most profitable parts of their practice.

Armstrong said the market for electronic health record services will take off once some hospitals start offering patients free access to their medical records online. “Once one hospital in one region offers this service for free, then all other hospitals or clinics will start doing so as well in order to maintain or gain competitive advantage,” said Armstrong. “If the health care enterprise dovetails the portal project with an existing electronic medical record or electronic health record project, then the costs of the portal could be reduced since that back end is now in place.”

Michael Martineau, director of the Branham Group, has similar predictions. Branham foresees a major increase in the automation of doctors' offices over the next 18 to 38 months. “It's the next frontier,” said Martineau. Alberta's physician office system program), for example, had 61 per cent of the province's physicians signed up as of July 2006, making it one of the leading jurisdictions in physician automation world-wide, it claims.

Martineau said to advance that uptake, companies in the electronic health record market in Canada will benefit by having their products certified by Canada Health Infoway's e-Health Collaboratory, an initiative designed to help vendors comply with CHI's e-health record standard.

“It shows the health care system that you are being part of the process, so it's a good corporate citizen thing to do,” he said.

But the biggest challenge Canadian companies face in cracking the e-health market is the lack of a Canadian “brand,” said Barry Gander, executive director of The Canadian Advanced Technology Alliance (CATA).

Canadian companies, he said, toil in obscurity not only within the country but on the global stage as well.

“If people are looking for a solution or a partner Canada doesn't come to mind,” he said. “We really have to adopt a co-ordinated strategy to become better known.”

That's what CATA hopes to change with the debut of its global webinars, described as “the founding step in the creation of a new healthcare community spanning the world's biggest block: the Commonwealth.”

Gander said the idea is to use the global webinars to present profiles of Canadian companies to build awareness of the capabilities that exist within Canada in an interactive way that can lead to Canadian partnerships and dealmaking.

“We need to fuse all these public sector needs with the knowledge of our private sector capabilities, and we're just on the beginning of that road now,” said Gander. “Our aim is to create a system where everybody knows what everybody else is doing.”

Another challenge Canadian companies face is the same one any Canadian company faces: Canada represents such a small market it's often not worth pursuing.

“The market (in Canada) is one-tenth of the size so when you're dealing with an organization in the U.S. with 600,000 members, the equivalent in Canada is 60,000,” said Jay Couse, senior vice-president of business development for Toronto-based Diversinet.

Diversinet, a vendor of mobile security products, for example, recently signed a deal with Blue Cross of Northeastern Pennsylvania (BCNEPA) to provide members access to their personal medical records through mobile phones, handheld wireless devices and personal computers using Diversinet's MobiSecure Wallet and Vault soft token technology.

Its business model is to make the technology available on an OEM basis to large health insurance providers.

Diversinet has built the back end but Blue Cross is responsible for the interface consumers will use, he said, as well as for negotiating the connections to the data.

The project will roll out to 100,000 users in the first half of this year, gradually scaling up to all 600,000 members.

“MobiSecure Vault is designed to give consumers the ability to access their personal information anywhere, anytime from a mobile device,” said Couse. “It acts like a remote control in that you don't have to store everything on the phone - the phone can be used as a pointer.”

The first phase of the project will allow consumers to access all the information warehoused by Blue Cross, such as insurance claims, as well as pharmacy-related and medical record information.

Americans, said Couse, are used to the idea of paying for health care, a concept that has not yet proved popular here at home.

‘In the U.S. market even if people have insurance they are paying US$250 a month on average,” he said. “They also pay a co-pay every time they visit the doctor … so their out-of-pocket costs can be very dramatic.”

That's not to say Diversinet is not interested in the Canadian market. Couse said the company is close to announcing a Canadian customer.

“They built the system to handle all the medial records at the physician level and we will then give our technology to them and they can give it to their patients.”

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