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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Business fills drug orders anywhere, anytime

Pleasanton firm creates vending machines that dispense prescriptions

PLEASANTON — Imagine living in a place with no drugstore for miles and miles but still being able to obtain prescription drugs and consult face-to-face with a pharmacist.

PickPoint Corp., based in Pleasanton, is making that possible.

And co-founder Richard Lee promises that they've only just begun to revolutionize the pharmacy world.

Lee is a resident of Volcano, which is about 60 miles east of Sacramento, but his co-founders Kevin Delaney and Peter Swidzinski are from the Valley. Lee works about three days a week in the Pleasanton office.

The idea for PickPoint started in 1999 and the business opened in Danville in 2000. After outgrowing that office, PickPoint moved to Pleasanton's Hacienda Business Park three years ago.

Lee had a background in factory automation and was interested in working on packaging for drugs when the PickPoint idea began.

The products are designed to store and dispense prepackaged medications of various types that will increase pharmacy efficiency and provide access to drugs for people in remote locations.

PickPoint's main product resembles a vending machine, but is filled with bottles and pill packs instead of candy bars and chips — and it's got bulletproof glass.

The security features allow the machines to be placed in distant locations such as Alaska's Aleutian Islands where the machine may be situated in a hut out in the middle of nowhere.

Doctors and other care providers use PickPoint's computer technology system to request a prescription from a pharmacist in Anchorage, Alaska, who can speak to the providers via video cameras in real time. The computer program also allows for close-up measuring and viewing of pills to ensure the prescription is correct.

"This is truly the next generation," Lee said.

In its few years of business, PickPoint has already attracted a wide customer base.

The military uses PickPoint's machines to run what is called a "telepharmacy" for its troops serving in remote locations, including ships.

The machines are installed in more than 125 U.S. Army, Air Force, Navy and public health service locations around the world.

The Alaska Native Medical Center, which uses PickPoint's technology, received the 2006 Award for Excellence in Medication-Use Safety from the American Society of Health-System Pharmacists.

The center established the Southcentral Foundation Telepharmacy Program based in Anchorage, with more than 36,000 patients in a 2,000-mile area.

"You can be anywhere, and we can give you pharmacy assistance and control," Lee said.

Even patients in the Valley can be served by PickPoint.

In addition to the machines set up in remote sites, PickPoint sells them to hospitals and pharmacies to keep behind the counter. The machines are the same except for the front door, which doesn't include bulletproof glass and allows pharmacy personnel to reach right in and grab the filled prescription.

The pharmacy inside Safeway near the Blackhawk community in Danville features PickPoint's machines behind the counter.

The pharmacy has the vending-machine style model as well as a set of drawers that light up to direct pharmacists to the location of a prescription.

The machines allow pharmacy staff to save time by re-allocating what work they do when, said Pharmacy Manager David Flower.

While pharmacists still have to fill individual bottles of pills and load the machine, the process is sped up by doing multiple bottles at once instead of over and over as each prescription comes in.

"The best advantage of this thing is when we do have downtime, we're using it up," Flower said.

Lee said PickPoint is currently working on other technology to improve the pharmacy world, but it won't be ready for a few months. He said people can begin to imagine getting their prescriptions filled in seconds rather than what is often an hour wait.

"The technology we have coming is so dramatic," Lee said. "This is stuff that people have never seen or heard of."

To learn more about PickPoint Corp., visit http://www.pickpoint.com.

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Insurers Back Free Electronic Prescriptions

January 16, 2007 - Washington - A coalition of insurers, technology companies and health care organizations is working to provide free electronic prescribing to every physician in America.

The National ePrescribing Patient Safety Initiative (NEPSI) is the first nationwide effort to prevent medication errors that kill 7,000 and injure 1.5 million each year, according to the Institute of Medicine (IOM) of the National Academy of Sciences. IOM has called on all physicians to adopt electronic prescribing by 2010.

"Electronic prescribing is clearly a tool that can dramatically reduce errors and improve patient safety," says Nancy W. Dickey, president of the Health Science Center, vice chancellor for health affairs at the Texas A&M University System and former president of the American Medical Association.

"Yet despite the many benefits of electronic prescribing, physician adoption is still modest,” says Dickey. “The situation calls for a solution that will overcome the barriers many physicians face in adopting this life-saving technology."

The challenge is that fewer than 1 in 5 of the nation's physicians process prescriptions electronically, according to the eHealth Initiative, a Washing-based group uses information technology to improve health care. Studies indicate that many have been deterred by the costs or by fears that the technology requires too much time to learn and install, the organization says.

NEPSI plans to help eliminate those barriers by providing simple, safe and secure electronic prescribing at no cost, advocates say.

A key element of the NEPSI initiative is participation by two of the nation's largest health benefits companies, Aetna and WellPoint, as well as influential regional payers such as Horizon Blue Cross Blue Shield of New Jersey.

The coalition's health benefits sponsors will provide incentives to physicians in their networks to encourage use of electronic prescribing technology. Their view is that electronic prescribing adds quality and efficiency to the patient care process, backers say.

"WellPoint views electronic prescribing as an essential tool in providing high-quality, safe and cost-effective care to our members," says Charles Kennedy M.D., Wellpoint vice president of health information technology. "We are excited about the potential of the NEPSI program to improve care when executed by our network physicians."

NEPSI is led by Allscripts, the provider of clinical software, information and connectivity that physicians use to improve health care, and by national sponsor Dell Computers Inc.
Other technology companies sponsoring NEPSI are Cisco Systems Corp., Fujitsu Computers of America Inc., Google Inc., Microsoft Corp., Sprint Nextel Corp., SureScripts Inc. and Wolters Kluwer Health Inc.

"The National e-Prescribing Patient Safety Initiative brings together a diverse group of technology companies, payers and physicians who share a commitment to one remarkable idea -- that providing free electronic prescribing for every physician will ultimately reduce errors and improve care,” says Glen Tullman, chief executive officer of Allscripts.

Tullman also calls electronic prescriptions an “on-ramp to a complete electronic health record" that could help consumers manage their health care and would follow employees from one job to the next.
Kevin Rollins, president and chief executive officer of Dell, says “information technology holds great promise as a means to help upgrade our nation's healthcare system technology."

"We believe that consumers will be the biggest beneficiaries of this technology adoption by physicians, enabling real-time access to the most relevant patient information,” says Steve Shihadeh, general manager of sales, marketing and partners for Microsoft's Health Solutions Group.

Craig Barrett, Intel chairman, who recently announced an initiative with employers to provide a personal health record system for employees, says: "Paper prescriptions are a key cause of cost, errors and inefficiency in U.S. health care. Which other industry could tell their customers it was OK to have a 15% imagine the airlines landing at the wrong destination 15 percent of the time.”

Electronic prescribing should be the rule not the exception, says Barrett. Electronic prescriptions, he adds, could provide timely and accurate information to employees through direct feeds to the Dossia lifelong health record. Dossia was announced in December by five big employers backing the project--Applied Materials, BP America, Intel Corp., Pitney Bowes and Wal-Mart.

NEPSI also includes more than a dozen academic medical centers, groups representing thousands of physicians across the country and integrated delivery networks Those organizations will serve as regional supporters of NEPSI, leading the delivery and support of electronic prescribing to physicians in their states and regions by providing education, training, incentives and local physician support.

Healthcare providers serving as regional supporters of NEPSI include Advocate Health Partners, Mount Prospect, IL; Brown & Toland Medical Group, San Francisco; Delta Health Alliance of the University of Mississippi Medical Center at Stoneville; George Washington University Medical Faculty Associates, Washington; Healthcare Partners Medical Group, Torrance, Calif.; Holston Medical Group, Kingsport, Tenn.; Louisiana State University Health Network, New Orleans; MaineGeneral Health, Augusta, Maine; Novant Health, Winston-Salem, N.C.; Sierra Health Services and Southwest Medical Associates, Las Vegas; University of Massachusetts Memorial Healthcare, Worcester, Mass.; and University of South Florida/USF Physicians Group, Tampa, Fla.

The backbone of NEPSI eRx NOW, Web-based software from Allscripts powered by the same engine used by more than 20,000 physicians to write millions of electronic prescriptions each year. Designed to appeal to physicians in solo practice or small groups, eRx NOW is available free to any healthcare provider with legal authority to prescribe medications, and requires no download, no new hardware and minimal training.

The product generates secure electronic prescriptions that can be sent computer-to-computer or via electronic fax to 55,000 retail pharmacies--more than 95% of all U.S. pharmacies. All prescriptions are checked for potentially harmful interactions with a patient's other medications, using a real-time complete medication database provided by Wolters Kluwer Health, as well as real-time notification of insurance formulary status from payers, plans and pharmacy benefit managers.

The product also allows physicians use a custom search engine from Google to search for health-related information. The NEPSI Custom Search Engine was created for medical professionals and when used with eRx NOW can obtain search results tailored for the medical community.
eRx NOW offers physicians and patients the highest security available, with redundant layers of firewall, deep-packet inspection, SSL encryption, database encryption, intrusion detection, and virus, spyware and malware protection for the program's remote servers.

To ensure privacy, all patient information is stored on remote servers in a secure location, so information cannot be compromised even if a physician's computer or phone is stolen.
Similar programs have succeeded regionally, proponents say. Blue Cross Blue Shield of Michigan, for example, has worked since early 2005 with General Motors Corp., The Ford Motor Co. and DaimlerChrysler Corp. on the Southeast Michigan e-Prescribing Initiative (SEMI).

Detroit-based Blue Cross, which provides or administers health care benefits to more than 4.7 million members , also worked on the plan with Detroit-based Henry Ford Medical Group, Health Alliance Plan (HAP) and pharmacy benefit manager Medco Health Solutions Inc.

BCBS of Michigan reported last year that more than 1,400 physicians had joined SEMI. Preliminary results showed improvements in generic drug prescribing rates and formulary compliance, as well as reductions in adverse drug events due to prescribing errors.

After writing a million e-prescriptions, more than 98,000 prescriptions were changed or cancelled because of drug-to-drug interaction alerts, and more than 63,000 prescriptions were changed or canceled because of formulary alerts, which increased the use of generic drugs.

Source: National ePrescribing Patient Safety Initiative

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Is your pharmacy providing 24/7 coverage?

Nov 20, 2006

By: Anthony Vecchione

Health-System Edition

At most large tertiary care hospitals and academic medical centers, around-the-clock pharmacy service is relatively common. But in some small and rural hospitals, 24-hour, seven-day-a-week pharmacy coverage is not economically feasible or practical. How are pharmacy services provided in those facilities? And how do health-system pharmacists feel about a Joint Commission on Accreditation of Healthcare Organizations proposal that would require all hospital pharmacies to provide 24/7 service?

Drug Topics commissioned a survey to understand how hospitals provide comprehensive pharmacy services off-hours and on weekends.

Here's a summary of the findings.

In response to the question, Does your hospital provide 24/7 pharmacy service? 64.3% of respondents answered in the affirmative.

Of those respondents who said their hospital has 24/7 pharmacy service, an overwhelming 87.9% indicated that their hospital had its own pharmacists on site 24 hours per day, while 6.4% reported that they used a pharmacist in a remote location to review drug orders during off hours. Only 5.7% of the respondents said that pharmacy services are provided by "other" means, but they did not elaborate.

According to pharmacists who do not have 24-hour pharmacy service, 93.8% stated that they use automated dispensing cabinets in the off hours, while 6.3% said that their hospital uses a locked cabinet with medications.

Of those respondents who do not have 24/7 pharmacy service, 88.4% said that their hospital has no plans to implement a 24/7 service next year, but 11.6% said that they intend to initiate such a plan.

When asked to rate their satisfaction with their pharmacy department's current 24/7 service, 27.7% of the respondents who have such pharmacy coverage said that they were extremely satisfied, 39.8% were very satisfied, and 29.5% were satisfied. Only 2.7% said that they are not satisfied with their current service and a mere .3% said that were not at all satisfied.

Some respondents explained why they are dissatisfied with their department's current 24/7 status. Here's what one had to say: "Only one pharmacist is on duty, what happens if he or she gets really busy or stuck in the ER? There's no one to call to cover." Another R.Ph. said, "We don't adequately staff the graveyard shifts. We don't have a plan in place for when demands exceed resources."

Thirty-two percent of the respondents said that their pharmacy operated on day and evening shifts but was closed overnight, while 10.5% reported that the pharmacy operated only from Monday through Friday but was closed on weekends.

Of the respondents who said that their hospital does not offer 24/7 pharmacy coverage, 35.6% reported that hospital staff members are allowed to access medications when the pharmacy is closed. However, 64.4% said that the practice was prohibited.

Of those hospital staff members who are allowed to access medications after-hours, 73% are nurses, 4.9% physicians, 1.6% paramedics, and 19.7% fell into the "other" category. Forty-two percent of respondents who reported that hospital staff members are allowed to access medications after-hours said that they can do so by using an automated dispensing machine outside of the pharmacy. Only 4.8% said that no arrangement has been set up for nonpharmacist personnel to access meds when the pharmacy is closed.

JCAHO oversight

When asked the question, Should JCAHO require all hospital pharmacies to provide 24/7 service? only 39% of respondents believe that JCAHO should require all hospital pharmacies to provide such service. Sixty-one percent disagreed with that premise.

The top two reasons why respondents believe that JCAHO should require hospital pharmacies to provide 24/7 coverage are the following: it will improve patient safety (33%) and patients will receive better care if a pharmacist reviews their drug regimen (26.7%).

Twenty-five percent of the respondents said that JCAHO-mandated 24/7 pharmacy coverage would improve the quality of the clinical care and operational aspects of the pharmacy service, while 12.2% said pharmacists would help reduce drug costs. About 2.5% of the respondents cited "other" reasons why JCAHO should require all hospital pharmacies to provide 24/7 coverage.

One respondent said that requiring all hospital pharmacies to provide 24/7 service would "make for better rapport between physicians, nurses, and pharmacists." Another pharmacist commented: "Pharmacists are the clinical medical experts and should be utilized 24/7. That's the business we are in."

How does your pharmacy allow other hospital staff to access medications after-hours?

Of the respondents who do not believe JCAHO should require all hospitals to provide 24/7 service, 44% said they feel this way because many small and rural hospitals cannot afford to provide that level of service. Thirty-one percent cited the pharmacist shortage and the difficulty in securing adequate pharmacy staffing. "I do not believe that there is enough work to demand that the pharmacy remain open 24/7," said one respondent. "If it's a small operation, very few orders are written during the night; a pharmacist should be on call," stated another respondent.

State regulations

Respondents were asked whether their state currently had established rules related to telepharmacy. Only 17.7% of respondents reported that their state had such rules, 20.8% said that their state did not, while 61.5% didn't know.

Almost 74% of participants who reported that their state had rules related to telepharmacy believe that those rules are a benefit because they establish parameters for telepharmacy to occur. In contrast, 10% said that those rules create a risk of displacing on-site pharmacists, while 4.3% said that the rules are too restrictive. Just over 11% expressed "other" opinions.

Respondents' satisfaction with their pharmacy department's current 24/7 service

Of the 20.8% of pharmacists who stated that no rules are established in their state regarding telepharmacy, 67.1% feel that their state board of pharmacy should enact rules that would allow for telepharmacy to take place.

In our survey, 40.6% of respondents think that telepharmacy services across state lines are an acceptable solution for extending night coverage. Here's what a few of these respondents had to say:

• "As long as the orders are being reviewed by a licensed pharmacist, I don't think it matters what state they are being reviewed in."
• "As long as the out-of-state pharmacist is aware of the different laws and able to make clinical decisions in providing patient care," telepharmacy across state lines is acceptable.
• "Health care is health care. What does an imaginary line on a map have to do with it?"

Those opposed to telepharmacy made these comments:

• "A physical presence of a pharmacist within the facility is needed to provide continuity of care to all patients no matter what the time of day or night. Different state laws may be a factor that can hinder care, as could a lack of knowledge of the particular patients and his or her treatment."
• "An on-site pharmacist is needed to dispense medication and respond to codes."

"An off-site pharmacist, especially in another state, cannot possibly handle pharmacy issues in another hospital, except to answer general questions."

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