Electronic Health Record Resources

by Moya K. Mason

25 Resources on Nursing Informatics Nursing informatics is the integration of computer science and information systems into the practice of nursing. It aims to boost the efficiency of data management and communication in the healthcare field, and in so doing, is revolutionizing the field of nursing.

A Case-Control Study of Autism and Mumps-Measles-Rubella Vaccination Using the General Practice Research Database: Design and Methodology British study, funded by the United Kingdom Medical Research Council, uses electronic health records to find a link between autism and the mumps-measles-rubella (MMR) vaccination. Electronic health databases offer tremendous opportunities for evaluating the adverse effects of vaccines. However there is much scope for bias and confounding. The rigorous validation of all diagnoses and the collection of additional information by parental questionnaire in this study are essential to minimise the possibility of misleading results.

A Comparative Study of EPR Projects in Denmark The Danish EPR-Observatory results of its monitoring of Danish EPR-projects, with a focus on experience gained, and various parameters, such as diffusion and diffusion rate. The EPR-Observatory, a public funded project organization - has monitored Danish EPR-projects with respect to various parameters such as diffusion and diffusion rate, barriers and limitations, experience gained. Furthermore, the Observatory has aggregated and disseminated the results and has established a constructive dialogue between the Danish EPR projects. The Observatory has also focused in the later years on analysis of common frames of reference for EPR systems. The National Board of Health and some of the larger counties have developed such frames. First generation systems have been implemented in a few counties with moderate coverage, but a number of projects developing second generation systems are making progress, and the market situation is quickly maturing. There are still, however, major problems in the practical implementation of the systems.

A Critical Pathway for Electronic Medical Record Selection Canadian paper that examines how EMRs impact the health care system in terms of privacy, efficiency, and quality of care. Electronic medical records (EMRs) are increasingly becoming a necessary tool in health care. Given their potential to influence every aspect of health care, there has been surprisingly little rigorous research applied to this important piece of emerging health technology. An initial phase of the COMPETE study, which is examining the impact of EMRs on efficiency, quality of care and privacy concerns, involved a rigorous critical pathway approach to EMR selection for the study. A multidisciplinary team with clinical, technical and research expertise led an 8-stage evaluation process with direct input from user physicians at each stage. An iterative sequence of review of EMR specifications and features, live product demonstrations, site visits, and negotiations with vendors led to a progressive narrowing of the field of eligible EMR systems. Final scoring was based on 3 main themes of clinical usability, data quality and support/vendor issues. We believe that a rigorous, multidisciplinary process such as this is required to maximize success of any EMR implementation project.

A European Health Card: Final Study This comprehensive working document for the Scientific and Technological Options Assessment of the European Parliament includes an introduction on health cards; a summary of EU projects; survey results; policy and technological options; market status in a number of European countries; and views and comments by organizations and interest groups.

A Framework for Modelling the Electronic Medical Record This British paper presents a model for an electronic medical record system that separates the record into two levels: direct observations of the patient, and meta statements about the use of observations in decision making and the clinical dialogue.

A Proposed Architecture and Method of Operation for Improving the Protection of Privacy and Confidentiality in Disease Registers New South Wales report proposes a system that will allow the efficient linkage of records between disease registers, while significantly improving the protection of privacy and confidentiality of the patients. The system proposed would significantly improve the protection of privacy and confidentiality, while still allowing the efficient linkage of records between disease registers, under the control and supervision of the trusted third party and independent ethics committees. The proposed architecture could accommodate genetic databases and tissue banks as well as a wide range of other health and social data collections. It is important that proposals such as this are subject to widespread scrutiny by information security experts, researchers and interested members of the general public, alike.

Achieving a Patient Unit Record Within Electronic Record Systems American paper on the difficulties involved in assuring that there is one unit medical record number for each patient in electronic record systems.

Act on Protection of Individuals with Regard to the Processing of Personal Data No. 77/2000 Icelandic Data Protection Commission translation of Act from May 2000. The purpose of this Act is to promote that personal data are processed in conformity with the fundamental principles and rules governing protection of such data and the right to privacy, to ensure reliability and quality of such data and the free flow of personal data in the internal market of the European Economic Area.

Advancing Electronic Health Records in Canada Sets out recommendations for ensuring the protection of patient privacy and confidentiality, and the meaningful ongoing input of the medical profession in the development of such EHR policy. This discussion paper has been developed to set out broad-based principles that should govern the evolution of Electronic Health Record (EHR) policy in Canada according to the Federal/Provincial/Territorial Advisory Committee on Health Infostructure (ACHI) Key Criteria and to set out recommendations for ensuring the protection of patient privacy and confidentiality, and the meaningful ongoing input of the medical profession in the development of such EHR policy.

AHA News This site also links to the bi-weekly publication of AHA News. One can also sign up for a free e-mail subscription to AHA News.

Alberta Association of Registered Nurses This resource is a valuable and authoritative resource that provides information regarding the nursing profession, specifically in relation to the province of Alberta.

American Medical Informatics Association The American Medical Informatics Association (AMIA) plays a pivotal role in the transformation of the US health system and makes measurable contributions to the improvement of health of the nation through continued development and implementation of health information technology.

American Medical News Produced by a reliable and authoritative source, AMNews is a good source of information regarding the current state of the health care system in the United States. It provides many search options and is a comprehensive resource.

An Adaptive Virtual-Reality User-Interface for Patient Access to the "Personal Electronic Medical Record" This paper describes the virtual reality user interface of the PREPaRe system and the adaptation mechanisms employed. The PREPaRe system (Personal Repository for Electronic Patient Records) is a patient-oriented internet-based information system that is able to store, combine, process and visualize all types of medical data that are part of a personal electronic medical record. Patients differ in levels of education and subjective needs. Therefore, a patient-oriented information system should provide mechanisms to adapt to these varying demands. This paper describes the virtual reality user interface of the PREPaRe system and the adaptation mechanisms employed.

An Evaluation of Patient Access to their Electronic Medical Records via the World Wide Web This paper describes the Webbased Patient Clinical Information System (PatCIS), a framework for the integration of applications that allows patients access to their electronic medical record, the ability to review online health information, to add data to their record, and to apply their own clinical data to guideline programs. This paper describes initial experience with the Webbased Patient Clinical Information System (PatCIS). The system was designed to serve as a framework for the integration of applications that help patients access their electronic medical record, add data to their record, review on-line health information, and apply their own clinical data (automatically) to guideline programs that offer health advice. The architecture supports security functions and records user activities, relieving application developers from concerns about safe information practices and the evaluation process. PatCIS is being used to study the social and cognitive impact of allowing patients to have access to their health records via the Web. To date, PatCIS has grown to include 15 clinical functions and 4 dynamic links to literature (called infobuttons). Eleven patients have been enrolled since April, 1999; five have been active users. Experience shows that the PatCIS architecture supports application integration while providing adequate security and evaluation functions. Initial caution with the patient enrollment process has limited recruitment and, consequently, usage. However, experience thus far suggests that PatCIS has good usability and utility. No adverse events, including undesirable impact on doctor-patient interactions, have been reported. There do not appear to be any technical impediments to scaling up the enrollment to continue to observe patient usage.

An Infrastructure for Integrated Electronic Health Record Services: The Role of XML (Extensible Markup Language) A full-text article from the Journal of Medical Internet Research. The sharing of information resources is generally accepted as the key to substantial improvements in productivity and better quality of care. In addition, due to the greater mobility of the population, national and international healthcare networks are increasingly used to facilitate the sharing of healthcare-related information among the various actors of the field. In the context of HYGEIAnet, the regional health telematics network of Crete, an Integrated Electronic Health Record environment has been developed to provide integrated access to online clinical information, accessible throughout the island.

An Integrated Electronic Health Record and Information System for Australia? Australian paper discusses the benefits of an integrated electronic health record for doctors and healthcare systems. It is almost 100 years since the introduction of the "unit record" at St Mary's Hospital in 1907 marked the beginning of the modern medical record. The centenary would be an appropriate target date for the full implementation in Australia of a national Integrated Health Record and Information System (IHRIS) which goes beyond existing institution-based, sector-based or system-based records to cover all contacts with the healthcare system. In 1997, the House of Representatives report Health on Line recommended the development and deployment of such a system. The idea of an integrated national approach has been endorsed by the UK National Health Service information policy. It includes plans to create a lifelong electronic health record by 2005. The New Zealand Health Department is well advanced in the implementation of an integrated health record system, and a number of healthcare funding bodies in the United States have introduced comprehensive electronic health records and information systems.

An Organisation with a Memory This report examines the key factors at work in organisational failure and learning, a range of practical experience from other sectors and the present state of learning mechanisms in the NHS before drawing conclusions and making recommendations. Its recommendations include the creation of a new national system for reporting and analysing adverse health care events, to make sure that key lessons are identified and learned, along with other measures to support work at local level to analyse events and learn the lessons when things go wrong.

An XML Portable Chart Format American paper that provides an overview of Portable Chart Format (PCF), which is creating standards for the transmission of patient charts using Extended Markup Language (XML). The clinical chart remains the fundamental record of outpatient clinical care. As this information migrates to electronic form, there is an opportunity to create standard formats for transmitting these charts. This paper describes work toward a Portable Chart Format (PCF) that can represent the relevant aspects of an outpatient chart. The main goal of the format is to provide a packaging medium for outpatient clinical charts in a transfer of care scenario. A secondary goal is to support the aggregation of comparable clinical data for outcomes analysis. The syntax used for PCF is Extended Markup Language (XML), a W3C standard. The structure of the PCF is based on a clinically relevant view of the data. The data definitions and nomenclature used are based primarily on existing clinical standards.

Analysing XML Health Records British paper that uses the Oswestry XML electronic patient record system as a backdrop for the analyzation of XML health records. What started out as a quest for a way of auditing free text gradually turned into a full electronic patient record system. The XML information system in Oswestry has been live for the past two years and contains half a million documents covering 50,000 patients. As elsewhere in the world the British National Health Service is under tremendous pressure from rising patient expectations and the inflationary pressures of technological medical advances. Failures of the system are often in the news whether these are related to human fallibility, criminal activity or simple inappropriate resource allocation. Medical data structured in XML allows examination of clinical activity with a power and scope never previously possible. Whilst a static data set can be indexed and searched in context using one of the many available SGML/XML aware systems dynamic data presents a greater challenge.

ARTFL Project: French-English Dictionary Form This resource has a useful search interface. There is a search box for both English-French and French-English translations.

ARTFL Project: ROGET'S Thesaurus Search Form This online thesaurus is free and has a useful search interface.

Better Health 2010: A Report by the AAMC's Better Health 2010 Advisory Board Association of American Medical Colleges report that puts ICTs and computerized health records at the forefront of a healthcare revolution. Twenty-first century medical schools and teaching hospitals are fulfilling their health care, education and biomedical research missions in an information landscape that is fundamentally different from that of any preceding time. In recognition of this, the Association of American Medical Colleges (AAMC) initiated better_health@here.now, a multi-faceted activity designed to help medical schools and teaching hospitals make optimal use of information technology and the Internet to improve the health of people and communities. Academic and health care organizations have been preparing for the Information Age for decades, building networks, installing computers, developing software and training staff and health professionals to be literate computer users. Fulfilling the promise of these technological capabilities begins with weaving the plethora of technology tools and information sources into a unified useful environment for education, discovery and health care. The widespread adoption of sound information management practices across academic and health care organizations is the key challenge of the next decade.

Bill 29 - Health Information Protection Act An act respecting the collection, storage, use and disclosure of personal health information, access to personal health information and the privacy of individuals with respect to personal health information and making consequential amendments to other acts.

Bioethics for Clinicians: Disclosure of Medical Error In this article we review the literature on such events and discuss the ethical, legal and practical aspects of whether and how they should be disclosed to patients. Ethics, professional policy and the law, as well as the relevant empirical literature, suggest that timely and candid disclosure should be standard practice. Candour about error may lessen, rather than increase, the medicolegal liability of the health care professionals and may help to alleviate the patient's concerns. Guidelines for disclosure to patients, and their families if necessary, are proposed.

Blueprint and Tactical Plan for a Pan-Canadian Health Infostructure December 2000 report on F/P/T Collaboration for the Planning of the Canadian Health Infostructure outlines a plan and strategy, and proposes recommendations on where to begin in the development of a Canadian Health Infostructure. Its intention is also to stimulate further planning and discussion regarding the development of a pan-Canadian health infostructure.

Blueprint for a National EHR Rollout National strategic program for implementing the electronic health record system in the United Kingdom. This 2002 paper uses the Cornwall EHR Project to focus in on the implications.

BMC Medical Informatics and Decision Making BMC Medical Informatics and Decision Making is an open access journal publishing original peer-reviewed research articles in information management, systems and technology in healthcare and the study of medical decision making. BMC Medical Informatics and Decision Making (ISSN 1472-6947) is indexed/tracked/covered by PubMed, MEDLINE, CAS, Scopus, EMBASE and Google Scholar.

British Medical Journal British Medical Journal.com launched in May 1995, the site contains the full text of all articles published in the weekly BMJ since January 1994 as well as material unique to the website.

Can XML Web Services Offer a Standard Across Databases? For the purpose of this article, we will focus on the role of data and XML as a key element for development. We will discuss topics that developers should consider as they approach data and database utilization with XML and even Web services. Assessing the state of the industry in terms of the role of data and XML leads to a recognition that XML is not being implemented consistently across all databases and that new technologies are emerging to help developers address this.

Canada Needs to Monitor, Prevent Medical Errors: Committee This is a useful resource geared to members of the public and medical communities of Canada. There are links to interviews with reputable sources in the field. This is a resource from the VPs link list under Communication.

Canada's Health Newsweekly: Health Edition Online Health Edition is a weekly, independent publication from Krysgar Communications Inc. that has been in production since 1996. Merck Frosst Canada & Co. sponsors free access to this newsletter as part of its commitment to foster dialogue about health reform in Canada. Merck Frosst, like Health Edition, believes health care is strengthened by communication. The more we know and talk about our health care system, the better it will become.

Canada's Research and Innovation Network / le reseau de recherche et d'innovation du Canada CANARIE's mission is to accelerate Canada's advanced Internet development and use by facilitating the widespread adoption of faster, more efficient networks and by enabling the next generation of advanced products, applications and services to run on them. Available in both French and English.

Canadian Centre for Policy Alternatives The Canadian Centre for Policy Alternatives is an independent, non-partisan research institute concerned with issues of social and economic justice. Founded in 1980, the CCPA is one of Canada's leading progressive voices in public policy debates. Canadian Centre for Policy Alternatives produces research studies, policy briefs, books, editorials and commentary, and other publications, including "The Monitor," a monthly magazine. Most of these resources are available at no cost on the site.

Canadian College of Health Service Executives Founded in 1970, the Canadian College of Health Service Executives (CCHSE) is a national, non-profit, professional association dedicated to developing, promoting, advancing and recognizing excellence in health leadership. Health leaders keep up-to-date on practices and trends through our highly respected, peer-reviewed, quarterly journal Healthcare Management FORUM and the annual Health Systems Update (HSU). The latter is a special report which identifies the issues and environmental factors affecting health delivery, and provides an annual update on health reform in Canada. It also publishes a monthly electronic newsletter for our members as well as books and position papers of interest to health leaders. Available in both French and English.

Canadian Health Network The Canadian Health Network (CHN) is a national, bilingual health promotion program found on the Web at www.canadian-health-network.ca. The CHN's goal is to help Canadians find the information they're looking for on how to stay healthy and prevent disease. The CHN does this through a unique collaboration - one of the most dynamic and comprehensive networks in the world. This network of health information providers includes the Public Health Agency of Canada, Health Canada and national and provincial/territorial non-profit organizations, as well as universities, hospitals, libraries and community organizations. Available in both French and English.

Canadian Health Record Association (CHRA) CHRA is a Canadian organization founded in 1924 to give health record professionals a forum to share their expertise in health record/information systems and management, while promoting patient access to health information, encouraging record retention, and focusing on issues of security and confidentiality.

Canadian Healthcare Technology Canadian Healthcare Technology is written and edited by a team of experienced business journalists, computer and healthcare consultants. The website offers selected full-text articles.

Canadian Nursing Informatics Association The mission of the CNIA is to be the voice for Health Informatics in Canada. Recognizing the importance of the work the CNIA is undertaking, the Canadian Nurses Association has granted affiliate group status to the CNIA. The CNIA is also affiliated with COACH, Canada's National Health Informatics Association. Through this strategic alliance CNIA is the Canadian nursing nominee to the International Medical Informatics Association - Special Interest Group in Nursing Informatics (IMIA-SIGNI).

Canadian Society of Telehealth A Canadian advocacy organization that is working for changes in health care through the utilization of information and communication technology: healthcare for anyone, anytime, anywhere. The Canadian Society of Telehealth leads the transformation of health care through information and communication technology by providing a forum for advocacy, communication and sharing of resources among our communities of interest.

Cancer Care Ontario Cancer Care Ontario is an umbrella organization that steers and coordinates Ontario's cancer services and prevention efforts so that fewer people get cancer, and patients receive the highest possible quality of care. As the provincial government's chief cancer advisor, Cancer Care Ontario directs over $500-million in public funding for cancer prevention, detection and care. The agency also operates screening and prevention programs; collects, monitors and reports information about cancer system performance; develops evidence-based standards and guidelines; and works with regional providers to plan and improve services for patients.

Cancer Care Systems: Meeting the Demands of 21st Century Healthcare Irish document that discusses electronic health records and fighting cancer.

Care for ICT, An International Research of ICT-Use in Healthcare in 8 Countries: Executive Summary, Country Profiles and Examples The Dutch Ministry of Economic Affairs invited PricewaterhouseCoopers to undertake an international comparative research study between September 2000 and January 2001 of ICT use in healthcare in the Netherlands. The objective was to establish the relative ICT position of the Dutch healthcare system in comparison with leading countries in ICT development, including Australia, Canada, Denmark, France, Germany, United Kingdom and the United States. Executive summary, country profiles and examples are included.

Checking Up on Medical Mistakes This article contrasts physicians' and patients' perceptions on medical errors - why they happen, how they could be prevented, how often and how serious they are.

CHISPA: Technology-Based Approach for the Acquisition of Cultural/Linguistic Competencies for the Multicultural Workplace The website includes support material for allied health professionals who would like information on ways to better understand the Hispanic patient. The website has the E-Pocketbook for Hispanic Patient Care, Hispanic care resources, Spanish language tools and practices, training materials, and a discussion forum - a communication tool for allied health professionals to communicate with each other about CHISPA related topics and how they use CHISPA in their school/facility.

Clinical Research Institute of Montreal (IRCM); Institut de recherches cliniques de Montreal (IRCM) The Institut de recherches cliniques de Montreal (IRCM), founded in 1967, is a non-profit organization devoted to studying the causes of disease, developing new diagnostic procedures and discovering preventive and therapeutic approaches that help to enhance our quality of life.

COACH - Canada's Health Informatics Association COACH is an organization dedicated to promoting a clear understanding of health informatics within the Canadian health system through education, information, networking and communication. COACH was formed in 1975 by several health professionals and vendors in the medical industry, who recognized that significant sharing of ideas and efforts must take place in order to enable Canadian health institutions to effectively use information technology and systems. The focus, 30 years later, has expanded to include not only the technology and the systems, but also the effective use of health information for decision-making. COACH believes in the importance and the value of strategic alliances with other organizations involved in the field of health informatics in Canada and internationally. It is committed to building a strong international network in health informatics through international organizations such as the International Medical Informatics Association (IMIA), and other national associations around the world. COACH is pleased to be Canada's official representative to IMIA.

Commission on the Future of Health Care in Canada The Commission on the Future of Health Care in Canada will make recommendations on sustaining a publicly-funded health system that balances investments in prevention and health maintenance with those directed to care and treatment. In accepting to head the commission, Roy Romanow says, "The task before us is to draw upon the ingenuity of all Canadians to ensure ... that our health system meets the challenges of the 21st century."

Communities of Practice Lots of material with a slightly different focus to most of what is written on Communities of Practice.

Communities of Practice The American Society of Civil Engineers offers information on Communities of Practice for civil engineers so that they can easily find information pertaining to their area of specialty. Each section includes up-to-date headlines and news, a listing of upcoming events, discussion groups and numerous other resource listings.

Communities of Practice and Organizational Performance As organizations grow in size, geographical scope, and complexity, it is increasingly apparent that sponsorship and support of communities of practice groups whose members regularly engage in sharing and learning, based on common interests can improve organizational performance. Although many authors assert that communities of practice create organizational value, there has been relatively little systematic study of the linkage between community outcomes and the underlying social mechanisms that are at work. To build an understanding of how communities of practice create organizational value, we suggest thinking of a community as an engine for the development of social capital. We argue that the social capital resident in communities of practice leads to behavioral changes, which in turn positively influence business performance. We identify four specific performance outcomes associated with the communities of practice we studied and link these outcomes to the basic dimensions of social capital. These dimensions include connections among practitioners who may or may not be co-located, relationships that build a sense of trust and mutual obligation, and a common language and context that can be shared by community members. Our conclusions are based on a study of seven organizations where communities of practice are acknowledged to be creating value.

Concepts for Integrated Electronic Health Records Management System Croatian paper presents the solution for a functional EHCR management system and addresses the problems of modularity and flexibility of medical information systems. Computer systems and communication technologies are making a strong and influential presence in the different fields of medicine. The cornerstone of a functional medical information system represents the electronic health records management system. Due to a very sensitive nature of medical information, such systems are faced with a number of stringent requirements, like security and confidentiality of patient related data, different media types management, diversity of medical data that need to be processed etc. At present most clinical software systems are closed with little or no operability between them, and the medical information are locked in a variety of different incompatible databases. As the result of these facts, it is very hard for the developers to provide the solution for an integrated health computing environment, which would considerably improve the quality of medical care in general. This paper presents the framework for a functional EHR management system that meets these demands, but also follows the initiative taken by the Next Generation Network (NGN) approach, which includes user mobility, service transparency and common communication platform for transferring and serving different types of information, services and media.

Confidentiality of Electronic Health Data: Methods for Protecting Personally Identifiable Information A National Library of Medicine bibliography on the confidentiality of electronic health data. Materials cited in this bibliography have been one source of input to a study of "best practices" for protecting the confidentiality of electronic health care data that is currently being undertaken by the Computer Sciences and Telecommunications Board of the National Research Council, under the chairmanship of Paul Clayton, Ph.D., Columbia-Presbyterian Medical Center. Funded by the National Library of Medicine and the Warren G. Magnuson Clinical Center, National Institutes of Health, DHHS, the study is also collecting data through a series of site visits to institutions with electronic health information systems. Its final report, scheduled for release by January 1997, will bring us a step closer to the goal of developing practical and coherent guidelines for protecting the confidentiality of electronic health data.

Dentistry in the New Millennium: An Information and Technology Strategy for Dentistry in Scotland The development and implementation of the Electronic Health Record will play a significant role in improving the oral and dental health of the Scottish population. The recommendations for change highlighted by the National Dental Information Working Group are included in the report.

DM Review This is a very comprehensive website that covers IT/Business Intelligence issues. Many resources on this site are available for free.

Doctor Global Doctor Global is a New Zealand company that was founded in 1999 to develop web-based solutions for problems in the healthcare system. One of their specialities is the creation of electronic health record software, such as "MyLife Health Record."

Doctors Use of Electronic Medical Records Systems in Hospitals: Cross Sectional Survey This full-text article from British Medical Journal compares the use of three electronic medical records systems by doctors in Norwegian hospitals for general clinical tasks.

Draft Health Privacy Guidelines On 21 December 2001, new privacy law comes into effect across Australia that will regulate the way private sector organisations handle personal information. The new law, which will be part of the Privacy Act 1988, includes ten National Privacy Principles (NPPs) that set standards for the way organisations, including health providers, handle personal information. The new privacy laws will give individuals new privacy rights including the right to have access to the personal information an organisation holds about them. Individuals will also have the right to complain if they think an organisation has breached their privacy rights and to get redress if the breach is proven. The Federal Privacy Commissioner, under s.27 of the Privacy Act, has the power to make guidelines about the NPPs. This document is a draft of one of those sets of guidelines.

Effect of Different Forms of Information Produced for Cancer Patients on Their Use of the Information, Social Support, and Anxiety: Randomised Trial To explore the hypothesis that different methods of selecting and printing information for cancer patients could improve emotional support by affecting interaction with others, and so lead to improved psychological wellbeing. Patients were more likely to show personalised information to their confidants than general information. Further research is needed into the effects of sharing information on patients' social support and anxiety.

E-Governance and Efficiency in Health Services: Putting People at the Heart of ICT and Health A presentation at the Regional Workshop on Building e-Governance Capacity in Africa on incorporating electronic health record systems into Africa's healthcare infrastructure.

E-Health 2001: The Future of Health Care in Canada Speech by George Radwanski, Privacy Commissioner of Canada on patient privacy in the information age.

E-Health 2007: Paths to Transformation This year's conference theme is to showcase an unprecedented number of e-health applications that are beginning to deliver on the expected benefits of improved patient outcomes, improved patient safety and improved cost effectiveness in the delivery of care. The program content promises to deliver unparalleled advances in electronic health records. Quebec City has all the advantages of a large city combined with exceptional natural features only a few minutes from centre town. Located in the St. Lawrence River Valley, Quebec city is divided into two distinct parts -- one perched high on the promontory overlooking the river, the other down by the shoreline where the first settlement was built. Quebec is beautiful and unique.

eHealth International The eHealth International Journal provides a peer-reviewed vehicle for timely publication of scientific research on the application of information technology in medicine, medical care delivery, and public health. The Journal encompasses those activities and programs leveraging information technology for medical and health education, treatment of illness and prevention of disease, promotion of healthy life style, and protection of the living environment. This includes telemedicine, telehealth, distance education, medical informatics, electronic information systems, and biotechnology. The Journal serves as a forum for the dissemination of accurate information and scholarly discourse on topical issues from the local to the national, regional, and international levels. It incorporates original research studies, critical literature reviews, policy analysis, program descriptions, technological developments, professional communication, book reviews, and occasional special features. It is published electronically on a quarterly basis. To promote the widest readership possible, the Journal is offered free of charge through the support of the International eHealth Association.

e-Health Records European Health Telematics Observatory presents links to articles, organizations, projects, and events regarding electronic health records.

EHealth: The Potential for Radical Change to Health-Care Delivery An Empire Club of Canada Speech, 2000-2001 given by Tom Closson, President and Chief Executive Officer, University Health Network.

E-Learning for the Workplace: Creating Canada's Lifelong Learners Information and communications technologies are changing how employees work and learn. At the same time, many employers recognize that their employees need to improve their knowledge and skills and that e-learning is a way to do so. This report shows why e-learning is important; provides examples of e-learning solutions; and contains a toolkit employers can use to develop their own e-learning strategy. This study was completed with financial support from the Office of Learning Technologies, Human Resources Development Canada; however, responsibility for this report and its contents rests solely with The Conference Board of Canada.

electronic Child Health Network (eCHN) The electronic Child Health Network (eCHN) is an example of an electronic health record (EHR). It is a non-profit organization based in Toronto that uses computers to allow access to health information among health care providers, children, and parents.

Electronic Commerce in Canada The Electronic Commerce Branch is responsible for encouraging the development and adoption of e-business in Canada. Canada is a world leader in the adoption, use and development of e-business. The Electronic Commerce Branch of Industry Canada aims to build on this foundation to support and facilitate continued growth of e-business in the Canadian economy.

Electronic Health Record (EHR) Standards Survey A full-text 2001 survey commissioned by IBM. This report is a short survey about the main emerging standards that relate to EHR - Electronic Health Record. EHR, a major component of the health informatics domain, is defined as digitally stored healthcare information about an individual's lifetime with the purpose of supporting continuity of care, education and research. It includes such things as observations, laboratory tests, diagnostic imaging reports, treatments, therapies, drugs administered, patient identifying information, legal permissions, and so on. EHR systems will contribute to more effective and efficient patient care by facilitating the unification of clinical information from large populations of patients across care sites. Transferring patient information automatically between care sites will speed delivery and reduce duplicate testing and prescribing. Automatic reminders will reduce errors, improve productivity, and benefit patient care. EHR is sometimes also called Computer-based Patient Record (legacy CPR), or Electronic Patient Record (EPR), or Electronic HealthCare Record (EHCR), or electronic medical record, or longitudinal health record.

Electronic Health Record Roll Out Puts Patient at Centre of British National Health Service In 2001, British Health Secretary, Alan Milburn, announced that within four years, U.K. adults will be given access to their own electronic health record as part of a seven year plan for the modernization of its NHS information systems.

Electronic Health Record Systems: Present Situation, Lesson Learned and Future Challenges EHCR Conference, Nyborg, September 2001 presentation on electronic health records.

Electronic Health Records and Systems Provides links to European Union EHR initiatives. This research activity has spanned a ten year period, through several EU and national projects, on the requirements and information architecture and implementation of comprehensive, interoperable and medico-legally rigorous EHR services. The set of projects below summarise the key milestones in this journey that has informed EHR standards in Europe and encompasses live clinical demonstrators in London and Devon.

Electronic Health Records and the Personal Information Protection and Electronic Documents Act Electronic health records (EHRs), a comprehensive record of an individual's health care history, are currently a subject of much interest and debate, both in Canada and abroad. While EHRs have the potential to improve health care delivery and facilitate planning and research, they raise significant concerns regarding the privacy, confidentiality and security of personal health information contained in the record. By their nature, EHRs are intended to permit easy transmission of patient information among those who have a legitimate purpose in accessing and using the record. However, concerns arise in regard to unauthorized access, use and disclosure of sensitive data contained in EHRs. Jurisdictions across Canada have enacted legislation aimed at protecting the privacy of personal information about identifiable individuals. Until recently, much of that legislation has operated only in the public sector. Several provinces -- Alberta, Saskatchewan, Manitoba and Ontario -- have enacted privacy statutes aimed specifically at health information. Between 2001 and 2004, federal private sector privacy legislation, the Personal Information Protection and Electronic Documents Act came into force in a graduated process. As of January 1, 2004, this statute applies in the health sector within a province to organizations that collect, use and disclose personal information during the course of commercial activities, as well as to crossborder flows of personal information for commercial purposes. There has been debate as to whether PIPEDA applies to health care providers who are funded through the public health insurance system, but this controversy has been resolved in favour of the position that those activities are still of a commercial character. In addition to private practitioners who bill the public system, PIPEDA will also apply to practitioners who bill patients privately and to entities such as pharmacies and private laboratories. As these organizations and individuals participate in EHR systems, PIPEDA will impact the collection, use and disclosure of personal information via that mechanism.

Electronic Health Records in Europe: A Shared Vision for Tomorrow This is the full-text presentation on EHRs in Europe given in 2002 by Alan Garfield. Efforts to develop an electronic health record, variously called EHR, EMR (electronic medical record), EPR (electronic patient record), EHCR (electronic healthcare record), GEHR (good electronic health record), and HCR (healthcare record) have been underway in many parts of the world for many years. In the United States, independent doctors, followed quickly by insurance companies (then by managed groups such as HMOs and finally by the federal government's DHHS the Department of Health and Human Services) have initiated the lead.

Electronic Health Records: An International Perspective This article by Amanda Cornwall gives an overview of a selection of EHR projects in Canada, England, Germany, France and Ireland. Development of electronically linked patient records or Electronic Health Record schemes (EHRs) is a priority for governments in many countries, including Australia, as part of a vision for future health care services using call centres, web-based patient information and telehealth. This article discusses the privacy framework needed for EHRs and the role of Privacy Commissioners. It reviews nationally significant EHR schemes in Canada, England, Germany, France and Ireland and the privacy frameworks they operate within.

Electronic Health Records: Issues for Discussion Leading to a Policy Framework Scottish paper discusses EHRs and the issues involved in an effort to develop a policy and strategic framework for the creation of an electronic health records system, which includes a focus on the patient. This paper is designed to discuss and propose policy and strategic approach to development of Electronic Health Records. Several issues arise when thinking through the policy framework. These issues are aired here along with discussion. Programme Board are asked to come to a view where possible. In summary, the position put forward is that EHR should be more overtly patient-focussed than anything we have done thus far.

Electronic Patient Record Difficult to Implement in Dutch Health Care June 1998 article that explains some of the problems that the Dutch healthcare system faced in its plan for an integrated electronic health record system, and includes new initiatives to create an individualized health record.

Electronic Prescribing: Administration and Pharmacy Specification for NHS Trusts This April 2002 article looks at the problems and pitfalls that exist in regards to the implementation of an electronic patient record system, with a focus on hospital pharmacists.

Electronic Virtual Health Record This 2002 presentation is part of the Australian College of Health Services Executives.

Emergency Medicine: Change and Challenge This Canadian Association of Emergency Physicians' Submission to the Commission on the Future of Health Care in Canada contains a section on informatics and the electronic health record.

Enhancing the Electronic Patient Record by Improving the Transcription Upload Process of Clinical Documents Describes a simplified transcription upload process created for the University Health Network (UHN), Toronto, Canada, that enhances the electronic patient record system.

Ethical and Legal Issues in Electronic Health Information Systems: Report of the University of Toronto Joint Centre for Bioethics Working Group Report gives an overview of personal health information and privacy; provides the Draft Personal Health Information Protection Act (PHIPA); and explores the ethics of personal health information management. Developments in information technology promise to revolutionise the delivery of health care by providing access to data in a timely and efficient way. Information technology also raises several important concerns about the confidentiality and privacy of health data. New and existing legislation in Europe and North America may make access to patient level data difficult with consequent impact on research and health surveillance. Although research is being conducted on technical solutions to protect the privacy of personal health information, there is very little research on ways to improve individual's power over their health information. This paper proposes a health care information directive, analogous to an advance directive, to facilitate choices regarding health information disclosure.

European Health Telematics Observatory e-Health Records Links The EHTO presents a list of EHR links that include information on legal matters and security issues, standardization, news, events, projects, as well as organizations and institutions.

European Physicians Especially in Sweden, Netherlands and Denmark, Lead U.S. in Use of Electronic Medical Records Harris Interactive takes a look at how general practitioners in Finland, the Netherlands, Sweden, Denmark and the United Kingdom are using electronic technology in their practices. This includes the use of computers, PDAs, the Internet, Electronic Medical Records, and practice web sites. General practitioners in Scandinavia, Netherlands and UK are using IT more than other doctors in European countries and more than primary care physicians in the U.S. As American health care leaders try to find ways to increase the use of the Internet and electronic medical records -- which they believe would improve the quality of care and reduce medical errors -- they might take a look at what is happening in some, but by no means all, European countries. Specifically they should look at what is happening in medical practices in Finland, the Netherlands, Sweden, Denmark and the United Kingdom, which are using IT more than most other European countries.

Evolving Communities of Practice: IBM Global Services Experience In 1995, IBM Global Services began implementing a business model that included support for the growth and development of communities of practice focused on the competencies of the organization. This paper describes our experience working with these communities over a five-year period, concentrating specifically on how the communities evolved. We present an evolution model based on observing over 60 communities, and we discuss the evolution in terms of people and organization behavior, supporting processes, and enabling technology factors. Also described are specific scenarios of communities within IBM Global Services at various stages of evolution.

Experience with an Electronic Health Record for a Homeless Population This paper from the Massachusetts General Hospital, Boston, MA describes an electronic medical record (EMR) system that was created for the Boston Health Care for the Homeless Program (BHCHP) to help doctors provide health care to the homeless population of Boston. Although further work is always needed to refine such an application, overall, the stakeholders consider the project a success and think that the electronic medical record has become an accepted asset in providing care for their homeless population. A computerized electronic medical record (EMR) system using client-server architecture was designed and implemented by the Laboratory of Computer Science for use by the Boston Health Care for the Homeless Program (BHCHP) to meet the unique medical record needs of the homeless. For the past three years, this EMR has been used to assist providers in the delivery of health care to the homeless population of Boston. As the BHCHP has grown and technology improved, it is important to review what features of the EMR work, and to investigate what improvements can be made for the better delivery of care to the homeless, especially as we approach the next century.

Fam-Med -- Information Technology in Family Medicine Listserv Fam-Med is an e-mail listserv that was established in 1990 as a vehicle for discussion about the use of information technology amongst family physicians on an international scale. Topics of interest include the computerization of the patient record. Fam-Med is an e-mail discussion group (or Listserv list) focused on the use of information technology in Family Medicine. Our members are from around the world and the majority are family physicians. The forum has been active since November of 1990. Anyone is welcome to join.

Federal Privacy Act -- Australian Copies are available for download in various formats. Privacy Act 1988 (Cth) - PDF, Word, zipped, HTML.

From Electronic Patient Record to Patient's Electronic Record: Next Decade European Solution for an Electronic Patient Record? Finnish paper that presents possibilities to assist health care organizations to integrate coming information systems, including an electronic wallet, a smart card, and networking caregivers and hospitals with broadband telecommunications. In the health care the rapid development of technology and customers' increasing self-consciousness of their own health have caused serious changes. Based on these changes, the visions of integration of health care information system should now be re-assessed. In this situation it would be important to decision-makers learn to know best practices to avoid unprofitable investment. In this paper we are first presenting four possibilities how health care organisations could integrate coming information systems; networking hospitals with broadband telecommunications, networking all caregivers, a smart card to store information and an electronic wallet to store information. According to the advantages and disadvantages of these possibilities we are then presenting our recommendation how electronic patient records and integration between caregivers should be organised in Europe.

From Information to Application: How Communities Learn The purpose of this review is to summarize selected literature sources on the subject of community learning and to identify the key themes arising from these sources. The findings of this work will be applied to the subsequent stages of the Understanding the Early Years project being undertaken by the Department of Human Resources Development Canada. The first stage of the Understanding the Early Years project focussed upon the collection of indicator data in six communities across the country: Southwest Newfoundland, Prince Edward Island, Toronto (North Quadrant), Winnipeg (Inner city), Prince Albert and Coquitlam, BC. The next stages of this project are intended to develop the tools to help communities work with this data. A wide range of materials from a number of diverse fields was explored for this literature review. While the materials derive from various fields, they can be grouped into one of two categories. The first category of literature can be considered highly theoretical and focussed upon the major dimensions of learning from biological, psychological and social perspectives. These sources typically present high-level concepts that may be applied to everyday practice. This work generally was carried out by academics and policy institutes, and was published by universities or organizations like the Organization for Economic Co-operation and Development (OECD).

Getting Data Out of the Electronic Patient Record: Critical Steps in Building a Data Warehouse for Decision Support Canadian paper on the development of an online analytical processing (OLAP) capacity of an electronic patient record system, and includes the steps taken for evaluation, retrieval, and creation of an analytical data warehouse accessible for analysis. Health care has taken advantage of computers to streamline many clinical and administrative processes. However, the potential of health care information technology as a source of data for clinical and administrative decision support has not been fully explored. This paper describes the process of developing on-line analytical processing (OLAP) capacity from data generated in an on-line transaction processing (OLTP) system (the electronic patient record). We discuss the steps used to evaluate the EPR system, retrieve the data, and create an analytical data warehouse accessible for analysis. We also summarize studies based on the data (lab re-engineering, practice variation in diagnostic decision-making and evaluation of a clinical alert). Besides producing a useful data warehouse, the process also increased understanding of organizational and cost considerations in purchasing OLAP tools. We discuss the limitations of our approach and ways in which these limitations can be addressed.

Global Health Resources Global Health Resources provides access to international health resources, including: e-newsletters; global factoids; who's who in international health care; summit resources; a global policy library; country health policy articles and research; daily global healthcare news; global organizational resources; and networking opportunities.

Guidelines in Healthcare: The Experience of the Prestige Project European paper on the Prestige Project, a collaboration of thirty organizations from eight countries working together to develop and implement a telematics infrastructure. Included in this infrastructure is the implementation of the Electronic Patient Record.

Headings for Communicating Information for the Personal Health Record European report on the Headings for Communicating Information for the Personal Health Record Project, with an overview of the implications for the Headings towards the use of Electronic Healthcare Records in place of paper records across Europe. This report is one of a series of initial evaluations of the Headings work being undertaken nationally. It provides an overview of the implications for the Headings Project of the progress across Europe towards the use of Electronic Healthcare Records in place of paper records. The document reviews the present initiatives that are taking place as enabling formalisms, methodologies and technologies to support the wide-scale adoption of EHCRs. And comments on the ways in which the present set of Headings might relate to them. These focus on the development of EHCR architectures, formalisms to represent medical knowledge, and the use of standardised messages for communication.

Health Affairs: The Policy Journal of the Health Sphere This journal focuses on U.S. health issues. Health Affairs is a bimonthly, peer-reviewed journal that explores health policy issues of current concern. Health Affairs Online contains the current issue, online-only Web Exclusives articles, and an archive of all past issues since 1981.

Health and Health Care Information Networks With GPs in Belgium: A Swot Analysis An interesting presentation that incorporates information on the future of EHRs in Belgium.

Health Canada News One way to keep on top of Health Canada's breaking health news, is to subscribe to one of their free news services. Health Canada now provides RSS feeds of its News Releases and Advisories, Warnings and Recalls. Our Media News Service is an effective way for journalists to keep up-to-date on breaking Health Canada news. The "Health Canada News Digest" is a monthly compilation of news headlines that is sent out to members who range from the general public to health professionals. It's "Your Health" is a series of timely fact sheets intended for the general public, the media and special interest groups, and is published by Health Canada and the Public Health Agency of Canada for Web and print publication.

Health Care Treatment Prices in Swedish Hospitals Among the important reforms to the Medicare model in Stockholm, no single step has been of greater importance than the restoration of prices for health care procedures in hospitals. The acronym for the price tag per treatment is known as Diagnostic Related Group. The DRG price mechanism, introduced in 1990, underpins the remarkable increases in productivity and efficiency in the delivery of publicly funded Swedish health care. By attaching an official price tag to every hospital treatment, government budget makers enabled providers both to improve their performance and to shift the system's focus to the needs of health-care consumers.

Health Data Standards: The Players A comprehensive list of organizations that develop health standards.

Health Identifiers: Options in an Electronic World The Australian National Electronic Health Records Taskforce report on health identifiers. New information and communication technologies create opportunities both to improve patient care and simultaneously give consumers more control over health care decisions that vitally affect them. The use of these new technologies can also lead to better quality information about our health services, allowing better planning and the provision of more cost-effective health care services, including for people living in regional Australia. The key to this opportunity is the potential for new technology to provide the right health care information, wherever it is needed, when it is needed.

Health Informatics Forum: Discussion Forum for Health Informatics Professionals and Students The Health Informatics Forum website is a Social Network for Health Informatics professionals, students and academics. Our members include many leading academics and researchers in the field of Health Informatics.

Health Informatics Glossary The Guide to Health Informatics has been written for healthcare professionals who wish to understand the principles and applications of information and communication systems in healthcare. The text is presented in a way that should make it accessible to anyone, independent of their knowledge of technology. It should be suitable as a textbook for undergraduate and postgraduate training in the clinical aspects of informatics, and as an introductory textbook for those undertaking a postgraduate career in informatics.

Health Informatics New Zealand Health Informatics New Zealand (HINZ) is a national, not-for-profit organisation whose focus is to facilitate improvements in business processes and patient care in the health sector through the application of appropriate information technologies. Health Informatics New Zealand emerged in September 2000 from two health informatics organisations: Nursing Informatics New Zealand (NINZ) and New Zealand Health Informatics Foundation (NZHiF). Nursing Informatics was originally formed in 1990 and NZHiF was originally formed in 1994.

Health Informatics World Wide Health Informatics World Wide is a regularly updated index of the most relevant links to websites on Health Informatics, Medical Informatics, and Nursing Informatics. Health Informatics World Wide lists related institutions and associations. The entries are alphabetically ordered by country and location. The acronyms following the link descriptions (e.g. AIM, BIO, CBT) refer to the main research, development and teaching areas of each institution. The key for these acronyms is to be found at the right side of each page. By clicking on one of the acronyms you can also search the site by topic area. The information on each institution reflects exclusively the data available from its WWW pages. The index focuses on institutions of research and education. The editors reserve the right to decide which institutions are being listed.

Health Informatics: Electronic Healthcare Record Communication, Distribution Rules European Prestandard report that specifies data objects for describing rules for distribution or sharing of electronic healthcare, while preserving security principles. This document was prepared by CEN/TC 251 PT028 and seeks approval from CEN/TC 251 during its meeting commencing on 1998-10-21 as a First Working Document (FWD) and to distribute this document to a wider audience with the Request for Comments, also known as the Red Cover procedure. This Draft First Working Document has been prepared under a mandate given to CEN by the European Commission and the European Free Trade Association. This Draft First Working Document is Part Three in a Four Part European Prestandard, relating particularly to rules that may be constructed to implement the automated control of the distribution of the Record Component as described in the Electronic Healthcare Record Extended Architecture Part One. The main body of the text and Annex A are normative. All other annexes are informative. The need to distribute Electronic Healthcare Records in whole or in part, whilst at the same time preserving security principles, has been the prime motivation behind the writing of this part European Prestandard. However, the need for the opportunity for the Subject of Care to take a central role in their Electronic Healthcare Record or its components being distributed outside an information system to potential data users has taken priority over all other issues. The EU Data Protection Directive [95/46/EC] and the Council of Europe Recommendation on the Protection of Medical Data R(97)5 have also been central to the development of these Distribution Rules. Serious consideration has been given to handling problems of access, not only to read from an Electronic Healthcare Record but also to add information from within the same care team and document correctly. The problems are closely related since in many cases there are two systems interacting: one sending and the other receiving information.

Health Information Act Chapter H-5 Read the Act on this site.

Health Information: A Personal Matter The Health Information Act sets out rules governing the collection, use and disclosure of health information. These rules will apply to all health care providers operating in the public health system. The details concerning a person's health status have long been considered the most sensitive type of information. Concerns about the privacy and confidentiality of health information are common to us all. At the same time, there is a strong view that health care information can be used to provide caregivers better information about people who need care, survey the health of Canadians, define the determinants of our health and better manage our health care system. While the Health Information Act provides for these uses of health information, it also affirms prevailing professional ethical obligations respecting confidentiality and security of health information. Significantly, the Act also provides a right of access by individuals to their personal health information.

Health Level 7 (HL7) HL7 provides standards for the exchange, management and integration of data that supports patient care and the management, delivery and evaluation of healthcare services. Health Level Seven is one of several American National Standards Institute (ANSI) -accredited Standards Developing Organizations (SDOs) operating in the healthcare arena. Most SDOs produce standards (sometimes called specifications or protocols) for a particular healthcare domain such as pharmacy, medical devices, imaging or insurance (claims processing) transactions. Health Level Seven's domain is clinical and administrative data.

Health Monitoring and Information Development Article on the transformation of the Australian healthcare system, with a section on the development of a national network for electronic health records.

Health Privacy in Ontario: The Road From Here Ann Cavoukian, Commissioner, IPC Ontario made a presentation at the 9th of May 2001 conference on Computerization of Health Records: Rights Issues, Societal Issues that focused on the threat of electronic health records and issues of privacy.

Health Privacy Project The Health Privacy Project is dedicated to raising public awareness of the importance of ensuring health privacy in order to improve health care access and quality, both on an individual and a community level. Founded in 1997 by Janlori Goldman, Director, the Health Privacy Project provides a broad array of healthcare stakeholders with the information and tools they need to work more effectively toward greater protection of health information through cutting-edge research studies, policy analyses, Congressional testimony, extensive work with the media, and a Web site.

Healthcare Informatics Healthcare Informatics is the most comprehensive, most widely circulated, and best read publication on healthcare information technologies. First published in 1984, Healthcare Informatics targets all levels of healthcare management involved in the assessment and purchase of information systems for healthcare facilities and organizations of all types. Healthcare Informatics serves readers in the rapidly growing $13 billion market for healthcare information systems. Learn more about making Healthcare Informatics your connection to this exciting marketplace. Healthcare Informatics is available free of charge to qualified individuals involved in healthcare technology.

Healthcare Information Management & Communications Canada (HIM&CC) Healthcare Information Management & Communications Canada (HIM&CC) is published by HC&CC, Healthcare Computing & Communications Canada, Inc. The magazine has been serving the Canadian Healthcare Industry since 1987. Aside from "newsy" items, the magazine publishes articles reflecting current issues, which pertain to today's volatile Healthcare environment. It is published in four quarterly editions and has an annual "Resource Guide" which is a tool for those interested in procuring consulting services and/or information technology and software applications.

Healthcare Information Management Systems Society The Healthcare Information and Management Systems Society (HIMSS) is the healthcare industry's membership organization exclusively focused on providing global leadership for the optimal use of healthcare information technology (IT) and management systems for the betterment of healthcare. Founded in 1961 with offices in Chicago, Washington D.C., Brussels, and other locations across the United States and Europe, HIMSS represents more than 20,000 individual members and over 300 corporate members that collectively represent organizations employing millions of people. HIMSS frames and leads healthcare public policy and industry practices through its advocacy, educational and professional development initiatives designed to promote information and management systems' contributions to ensuring quality patient care.

healthnetBC healthnetBC is the source for information and standards on developing the provincial Electronic Health Record. This enables the secure sharing of integrated health information to improve patient care, reduce duplication of services, and enhance management and planning for health service delivery.

Hospital Computerisation Offers Potential for Improving Disease Management Computerising hospital management and information systems offers Africa a number of potential benefits. Sceptics rightly protest: how can you even think about computers, when everything else is in a mess and there's no money. Perhaps these two positions are not as far apart as they seem. If African healthcare is to improve, it will obviously require greater resources. But even with greater resources, it will need improvements in management and administration to be able to handle increased resources. People capacity and training are almost as important as installing "kit". This week Helen Mellor of Elan Technologies describes how it computerised a group of hospitals in South Africa's Northern Cape and the potential impact on the work of the hospitals.

Hospital News This is a very useful resource for Canadian healthcare professionals. Hospital News is Canada's health care newspaper since 1987. Hospital News covers developments and issues that affect all health care professionals, administrators, patients, visitors and students. Hospital News is published monthly and is made available in distribution racks placed in high traffic areas in hospitals and related institutions across the country. It is also available by subscription. Hospital News keeps readers informed on current health-care news, medical advancements and trends in health care with a fresh perspective each month. Staff and experts in the health-care field submit articles that relate to the monthly editorial focus.

Implications of Pan-European Best Practice in eHealth Service Delivery This Netherlands paper looks at the impact that information technology potentially has on users of electronic health systems; good practices for electronic healthcare services; and future trends in Europe. The Prisma Project has examined a number of case studies of eHealth service delivery, and have considered the role of information and communications technologies in each case. This leads to a number of observations about the influence information technology may have on quality, cost and access in health care. In the following paper, the authors would like to further specify what impact information technology could have on the service users, the service providers and on the community as a whole. Based on discussions of European cultural realms, it also discusses what aspects are at stake when a successful technology is to be important in another country and what future trends are to be foreseen.

Improving Health Care Efficiency in Rural Areas: The Role of the Electronic Health Record This article written by Tom Mulholland explores how electronic health records can improve health care in rural areas of Australia. Doctor Global, an Australian web-based health records provider, is highlighted. Both health professionals and patients in rural areas are disadvantaged, health professionals through long hours and limited peer support and educational opportunities, and patients because they do not have the same level of access to health services as their urban counterparts. One key contributing factor to this incongruence in care for patients is the lack of a unique patient health record. Doctor Global is an Australasian health services and clinical software provider, which supplies web-based health records. The organisation's philosophy is based on the belief that online consultations and a web-based electronic health record (EHR) can increase access to health care, reduce errors, and create efficiency. Access to the health record via a secure database and the internet allows rural patients to remain informed and part of the process and assists with referral to specialists. No information is "sent"; it remains secure and available as a shared resource accessible to the consumer and all relevant health professionals.

Improving Health in Wales: The Future of Primary Care Electronic health records will play a role in the transformation of the Welsh health care system. The purpose of this document is to set out a strategy for primary care in Wales and what the aims should be to strengthen and develop services and to help and support primary health care teams in the vital work they undertake and on which we all depend.

Improving the Quality of Healthcare Through Health Information Exchange In summary, the number of health information exchange initiatives is up from last year, and such efforts are continuing to mature, with the engagement of an increasingly diverse set of stakeholders, the creation of formal structures and organizations, advancement in the development and implementation of business plans and models, and an increasing amount of electronic data being exchanged. However, challenges remain for such efforts, which include the ability to secure sufficient start-up funding and the ability for a majority of the initiatives to develop sustainable business models. The confluence of efforts surrounding not only information technology and health information exchange, but also requirements for and the alignment of incentives with quality improvement, create a near-term opportunity for transformation in the U.S. healthcare system. As efforts to both measure against and align incentives with goals around quality improvement and effectiveness continue to grow, health information exchange initiatives are beginning to explore expanding their services to offer an approach for supporting quality improvement that builds multi-stakeholder trust and creates a policy and technical infrastructure for information sharing with mutual agreement among providers, purchasers and payers. As the results of the 2006 survey indicate, increasingly multi-stakeholder efforts across the country have successfully engaged and begun to build trust among the diverse stakeholders in their regions to enable them to come together and create both information sharing policies and a technical infrastructure to support secure electronic information sharing while protecting patient privacy. In one-fifth of these initiatives, clinical data is already moving to support care delivery processes. And in about ten percent of such initiatives, data services are supporting quality improvement processes for clinicians as well as reporting requirements of purchasers or payers. As pressures on the system for quality and efficiency improvement continue to grow, policy makers at the national, state, and local levels should look to align policies for both quality and HIT, enabling the infrastructure currently being built in communities across America to support the mobilization of data for care delivery, to also support the infrastructure being contemplated to improve quality and efficiency. Both efforts require trust, the engagement of multiple stakeholders, special attention to information sharing policies related to privacy and confidentiality, and an electronic data infrastructure--and can benefit from being addressed in a complementary fashion. The eHealth Initiative will continue to assess trends and develop policies, principles and solutions--for which there is multi-stakeholder consensus--to drive improvements in health and healthcare, through information and information technology. This particular area of convergence--issues related to quality, and issues related to health information technology--will be the primary area of focus for eHI in the coming months, with the goal of accelerating the improvement of the quality, safety and effectiveness of healthcare for all Americans.

Improving the System: Capacity and Capability Building Australian paper from the Patient Management Task Force that outlines strategies to encourage health services to achieve benchmark performance in patient management. The Task Force proposes that the creation of an electronic health record, with privacy and confidentiality guidelines built in, will have great benefits for patients and for patient management. This paper includes specific proposals in a number of these areas, including: Developing a culture of collaboration and the sharing of information, experience and learning. Encouraging clinician and executive leadership and involvement. Accelerating the adoption of new IT-based technologies to optimise patient care. Fostering performance measurement and inter-hospital benchmarking. Refining and streamlining incentives and other driving forces in current funding systems (alongside adjustments to the health service agreement process). Planning and decision making about the role and location of metropolitan health services. Addressing Commonwealth--State issues that limit the ability to link Commonwealth funded services (such as general practitioners) with State funded services (such as hospitals). Informing the community and involving consumers in their health care (including disease management approaches).

Improving Your Competitive Advantage Through E-health Strategies A presentation from the Australian Financial Review 4th Annual Health Congress, 25-27 February 2002 that defines e-health, its foundations, the characteristics of sustainable competitive advantage, how to find sustainable competitive advantage, implementing e-health for competitive advantage, and e-health in 2005.

Indian Health Service Electronic Health Record A website devoted to the EHR initiatives of the U.S. Indian Health Service. These pages will introduce you to the Indian Health Service's new Electronic Health Record (EHR). The site is designed primarily for IHS, Tribal, and Urban (I/T/U) Indian health care facilities that are actively involved in implementation of the EHR, or are contemplating doing so in the near future. It provides a variety of information about the EHR product, as well as links to a number of helpful documents. The Indian Health Service has long been a pioneer in using computer technology to capture clinical and public health data. The IHS clinical information system is called the Resource and Patient Management System (RPMS). Its development began nearly 30 years ago, and many facilities have access to decades of personal health information and epidemiological data on local populations. The primary clinical component of RPMS, Patient Care Component (PCC), was launched in 1984. The RPMS EHR graphical user interface represents the next phase of clinical software development for the IHS.

Information and Privacy Commissioner of Ontario Since January 1, 1988, the IPC has acted independently of government to uphold and promote open government and the protection of personal privacy in Ontario. In this website, you will find numerous resources to assist in protecting your privacy and accessing information.

Information Infrastructure for an Integrated Healthcare Services Network Researchers from the University of Crete explore how the growing demand for more efficient, effective, and mobile healthcare services is forcing system developers to come up with new ICT-oriented organizational frameworks to increase accessibility of information and to assist in medical applications information processing. HYGEIAnet, the integrated regional health telematics network of Crete is spotlighted.

Integrated Electronic Health Records and Patient Privacy: Possible Benefits But Real Dangers Australian report on how the development of electronic health record systems need to incorporate the concerns of ordinary citizens, instead of dismissing them. Integrated electronic health records are increasingly seen as the way to achieve quality and continuity in treatment, fill the gaps in public health research and contain costs. However, such systems run the risk of foundering in the wake of community concerns, as has been the UK experience. Successful implementation of proposals for electronic record systems must learn from such experiences and demonstrate keen attention to delivering information useful to both citizens and clinicians, while ensuring privacy protection and promoting public accountability for secondary use of personal information.

International Activities Toward Electronic Health Records: Unique Identification and PKI An excellent overview of international activities in EHR (put out by Health Canada in 1998). A reliable system for patient identification, coupled with comprehensive policies and/or legislative acts protecting privacy of individuals and security of personally identifiable information, is a necessary component of the electronic health record implementation process in many health care delivery systems around the world. Many vital activities directly depend on correct identification of patients, such as the delivery of institutional care, health administration, information management and community care activities. The twentieth century is characterized by a revolution in provision of health care services. Advances in medical science and management have created an entirely new system of health care. People are not cared for by a single physician any longer. Instead, it is a collective process that includes nurses, many consulting physicians, laboratory technicians, diagnostic technologists and administrative staff. Moreover, a patient is no longer treated by one organization. A person can be admitted to one facility, transferred to another for treatment, and then require extended or home care. Therefore, it is necessary to uniquely identify patients across multiple providers and be able to access their information from multiple locations in order to support continuity of care.

International Medical Informatics Association The International Medical Informatics Association is an independent organization established under Swiss law in 1989. The organization was established in 1967 as Technical Committee 4 of the International Federation for Information Processing (IFIP). In 1979, it evolved from a Special Interest Group of IFIP to its current status as a fully independent organization. IMIA continues to maintain its relationship with IFIP as an affiliate organization. The organization also has close ties with the World Health Organization (WHO) as a NGO (Non Government Organization). The working language of IMIA is English.

Internet Infrastructures and Health Care Systems: a Qualitative Comparative Analysis on Networks and Markets in the British National Health Service and Kaiser Permanente Background: The Internet and emergent telecommunications infrastructures are transforming the future of health care management. The costs of health care delivery systems, products, and services continue to rise everywhere, but performance of health care delivery is associated with institutional and ideological considerations as well as availability of financial and technological resources. Objective: To identify the effects of ideological differences on health care market infrastructures including the Internet and telecommunications technologies by a comparative case analysis of two large health care organizations: the British National Health Service and the California-based Kaiser Permanente health maintenance organization. Methods: A qualitative comparative analysis focusing on the British National Health Service and the Kaiser Permanente health maintenance organization to show how system infrastructures vary according to market dynamics dominated by health care institutions ("push") or by consumer demand ("pull"). System control mechanisms may be technologically embedded, institutional, or behavioral. Results: The analysis suggests that telecommunications technologies and the Internet may contribute significantly to health care system performance in a context of ideological diversity. Conclusions: The study offers evidence to validate alternative models of health care governance: the national constitution model, and the enterprise business contract model. This evidence also suggests important questions for health care policy makers as well as researchers in telecommunications, organizational theory, and health care management.

JAMA JAMA, published continuously since in 1883, is an international peer-reviewed general medical journal published 48 times per year. JAMA is the most widely circulated medical journal in the world. JAMA is published in multiple international editions and languages; the online version is made freely available to institutions in developing countries. JAMA's impact factor is 23.5 (the impact factor is a measure of citation rate per article, and is calculated by dividing 1 year's worth of citations to a journal's articles published in the previous 2 years by the number of major articles [eg, research papers, reviews] published by that journal in those 2 years). JAMA's acceptance rate is approximately 8% of the nearly 6000 solicited and unsolicited manuscripts it receives annually; its average time from submission to publication is 115 days and average time from receipt to rejection is 23 days (for additional information, see the JAMA editorial).

JMIR - Journal of Medical Internet Research The Journal of Medical Internet Research is a peer-reviewed transdisciplinary journal on health and health care in the Internet age and a comprehensive e-Health research portal. This site provides free full-text access to all articles. One can browse the issues of the periodical.

Journal of the American Medical Informatics Association AMIA's bimonthly journal, JAMIA, presents peer-reviewed articles that assist physicians, informaticians, scientists, nurses, and other health care professionals develop and apply medical informatics to patient care, teaching, research, and health care administration. JAMIA has rapidly established a reputation for presenting high-quality, cutting-edge information. Each issue contains state-of-the-art reviews, discussion forums, and invited editorials presented as brief reviews or full-length papers. A variety of formats accommodates work at all stages, from model formulation through definitive studies.

Kaiser Permanente's Experience of Implementing an Electronic Medical Record: A Qualitative Study To examine users' attitudes to implementation of an electronic medical record system in Kaiser Permanente Hawaii. Design Qualitative study based on semi-structured interviews. Implementation involved several critical components, including perceptions of the system selection, early testing, adaptation of the system to the larger organisation, and adaptation of the organisation to the new electronic environment. Throughout, organisational factors such as leadership, culture, and professional ideals played complex roles, each facilitating and hindering implementation at various points. A transient climate of conflict was associated with adoption of the system.

KNOW Inc. A Canadian portal that brings together resources on knowledge management in general, with some specifically for communities of practice.

Management and Information Systems Module Overview The central theme for the module is the use of Information Systems in the management of organizations. Below is an overview of the module showing, on a lecture by lecture basis, the topic, associated key concepts and a brief indication of the content. Further details on each lecture topic can be obtained by following the links in the topic column. A brief summary of the module can be found in the final section: review and conclusions.

Manhattan Research This website is directly applicable to the healthcare field. One can sign up for a free industry newsletter for periodic updates, white papers, research highlights, conference presentations and information about upcoming events. Manhattan Research, LLC is a healthcare market research and services firm that helps healthcare and life sciences organizations adapt, prosper and explore opportunities in the networked economy. We focus on the intersection of technology and healthcare business trends and seek to understand the forces that will impact the competitive landscape for our clients.

Massachusetts Health Data Consortium Established in 1978, the Massachusetts Health Data Consortium, Inc. develops, collects, analyzes and disseminates information to improve the health and healthcare of the region. The Consortium brings together New England's key healthcare organizations for collaborative projects aimed at improving the healthcare environment.

MDINFO - Medical Informatics Mail List Discussion forum for medical informatics.

Measuring the Success of Your EPR Implementation Results of a survey to measure how Electronic Medical Record (EMR) implementations affect medical office processes, such as physician tasks. Computerization of physician practices is an on-going reality. With increasing fiscal restraint and a greater demand by all stakeholders for demonstrated value, it is important to measure the success of EPR implementations. Each stakeholder (physicians, patients, office staff, payers and administrators) has a different need for information and demonstration of value.

MEDARC Listserv The aim of this Australian listserv is to provide a forum for the discussion of the professional issues that medical records managers and archivists face in their work. This list is for the discussion, publication and promotion of professional issues and practice for medical records and archives professionals in Australia. The list has been established by the Australian Science Archives Project.

Medical Record Privacy Provides an overview of medical privacy, laws related to privacy of health information, and consumer advice.

Medical Records Institute The Medical Records Institute's (MRI) Mission is to promote and enhance the journey towards electronic health records, e-health, mobile health, and related applications of information technologies (IT).

Meeting New Standards for Managing Privacy of Health Information, Canadian Institute Reference contained in body of speech to Canada Health Infoway. References to various bodies that are producing codes related to privacy and health information.

Michigan Electronic Medical Record Initiative (MEMRI) Michigan Electronic Medical Record Initiative (MEMRI) is a Michigan-registered non-profit corporation dedicated to improving healthcare quality and lowering healthcare costs in Michigan through the implementation of a statewide, standardized electronic medical record. It is supported by physicians, technologists, state and global technology corporations, healthcare organizations, and statewide economic and technological development initiatives.

Moving from Debate to Action: Securing the Future for Canada's Health System This report offers a compilation of opinions expressed by over 100 senior stakeholders from Canada's health care system at a conference hosted by the Public Policy Forum in December 2002. EHRs formed a part of the discussion in many of the central themes. The Public Policy Forum (PPF) is a non-profit organization aimed at improving the quality of government in Canada through better dialogue between government, the private and third sectors. The Forum's members, drawn from businesses, federal and provincial governments, the voluntary sector and the labour movement, share a common belief that an efficient and effective public service is a key element in ensuring our quality of life and global competitive position. Established in 1987, the Public Policy Forum has gained a reputation as a trusted, neutral facilitator, capable of bringing together a wide range of stakeholders in productive dialogue. Its research program provides a neutral base to inform collective decision-making. This outcomes report reflects two days of intense dialogue among over 100 senior stakeholders from Canada's health care system who met at a conference hosted by the Public Policy Forum in December 2002. Moving from Debate to Action: Securing the Future for Canada's Health System brought together governments, policy-makers, health providers, and health system experts with the goal of identifying common ground and building momentum for renewal of Canada's health system. Although the timing of the conference was occasioned by the release of the Romanow Report, the discussions built on recommendations from a variety of health system studies conducted by federal and provincial governments.

Moving Towards an Electronic Patient Record: A Survey to Assess the Needs of Community Family Physicians Canadian paper on the results of a Hamilton, Ontario survey that looked at family physicians' needs regarding electronic patient records (EPRs). To determine the needs of community family physicians regarding electronic patient records (EPRs). A comprehensive survey was sent to 101 community family physicians in Hamilton, Ontario, who had expressed an interest in EPRs. Results: 46 physicians responded (46%). 87% felt that an EPR would result in their providing better patient care. A wide variety of items were deemed to be important to be included on the EPR front page. Desired functionality emphasized labs, medications, consultation, hospital follow-up and health maintenance. Family physicians tended to prefer templates to other data entry methods such as typing and dictating. Respondents were more willing to view information from the hospital than to let the hospital view information from their own offices. This survey provided useful information on the perceived EPR needs of community-based family physicians. It will be repeated post-computerization.

NC Health Info Launched in January 2003, NC Health Info was the first resource of its kind to link local health services with corresponding information in MedlinePlus, the consumer health Web site maintained by the National Library of Medicine.

Newfoundland and Labrador Centre for Health Information Recognized as an Emerging National Leader in Health Information Systems December 2002 article on Newfoundland's development of a client registry, a building block for the future development of electronic health records (EHR) in Canada.

NHS Confidentiality Consultation - FIPR Response Includes Bibliography

No End to Errors Washington Post article: Three years after a landmark report found pervasive medical mistakes in American hospitals, little has been done to reduce death and injury.

NSW Health Strategy for the Electronic Health Record New South Wales report provides information on the scope of the NSW electronic health record strategy, including its provisions for privacy and security, the changes that are needed, and the expected benefits to consumers, providers, and to the organization. In March 2000 the NSW Health Council set an objective for the NSW health system to implement the Electronic Health Record (EHR) by 2010, with significant progress in at least two Area Health Services within the first three years. There have been a number of key developments since that time, most notably Health Ministers in principle endorsement of the proposal for a National Health Information Network (HealthConnect). The objectives established by the Health Council remain appropriate. The EHR strategy sets out the direction to be taken by NSW Health to ensure that those objectives can be met, whilst taking advantage of initiatives occurring at the national level. The strategy will take account of the recent report of the Ministerial Advisory Committee on Privacy and Health Information. This committee endorsed the general approach taken by this strategy subject to appropriate controls over the privacy and security of information. The success of the strategy will not be determined by the deployment of the technology but by measurable improvements in the quality and outcomes of care and public health.

Office of the Information and Privacy Commissioner for British Columbia The Office of the Information and Privacy Commissioner (OIPC) is independent from government and monitors and enforces British Columbia's Freedom of Information and Protection of Privacy Act (FIPPA) and Personal Information Protection Act (PIPA). FIPPA allows access to information held by public bodies (such as ministries, universities and hospitals) and determines how public bodies may collect, use and disclose personal information. PIPA sets out how private organizations (including businesses, charities, associations and labour organizations) may collect, use and disclose personal information.

Office of the Information and Privacy Commissioner of Alberta: Homepage This site contains a variety of information pertaining to the provincial Freedom of Information and Protection of Privacy (FOIP) Act, the Health Information Act (HIA), the Personal Information Protection Act (PIPA), the Access to Motor Vehicle Information Regulation (AMVIR) and the Office of the Information and Privacy Commissioner (OIPC). This site has been designed to provide you with information needed to use and understand the FOIP Act, HIA, PIPA and AMVIR in addition to providing access to Commissioner's Orders, Investigation Reports and other publications from our Office.

Ontario Hospital Association The OHA believes that this time of health system transformation holds a great deal of promise and opportunity. This is why it took a step back in 2006, to confirm a role and mandate that responds to current health care challenges and opportunities while meeting member needs.

Ontario Pharmacists Can Help Provide a Safer Medication Use System This article offers a good general overview of the medication error reporting system in Canada. It is not substantive, but rather is an introduction to the issue. This resource is produced by a reputable source, notably, the Institute for Safe Medication.

Open Protocols Make Electronic Health Records Easier Downloadable From Remote Sites Italian article on the team of researchers who developed an EHR system for Brotzu Hospital in Cagliari.

Open-Source Software and the Primary Care EMR Bates et al. representing the National Alliance for Primary Care Informatics, identify several barriers to the adoption of electronic medical record (EMR) systems in primary care. Three barriers are highlighted: excessive cost, the transience of vendors, and the lack of common data standards. This otherwise excellent review fails to draw attention to the phenomenon of open-source software (OSS). OSS may turn out to be the force that helps overcome these and several other barriers to the use of the EMR in primary care and in the rest of the health care system. The medical informatics community should welcome OSS, which fits naturally our scientific model of shared, peer-reviewed knowledge in medicine. It holds great promise for realizing the vision of ubiquitous, low-cost, electronic medical record systems to improve primary care.

OpenEHR The openEHR Foundation is a non-profit organisation bringing together an international community of people working toward the HER; lots of full-text resources here. openEHR is an international not-for-profit foundation, working towards making the interoperable, life-long electronic health record a reality and improving health care in the information society.

Overview of GEHR from an Australian Perspective Good European Health Record (GEHR) project and the development of a standard record architecture is discussed. Efforts to develop an electronic health record (EHR) have been underway in many parts of the world for many years. A great deal has been learned from these efforts but no implementation of any published efforts to produce standards has so far taken place. The approach to standardisation in Europe and a number of other countries including Australia has moved away from a minimum shared dataset to a standard record architecture.

PACS and Electronic Health Records This White Paper goes through the high-level technical processes, explaining the different clinical data structures from an expert's point of view. IBM Haifa Research Labs states that the creation of EHR systems is best achieved by converting PACS medical images into HL7 standard XML documents for better accessibility and correlation. Electronic Health Record (EHR) is a major component of the health informatics domain. An important part of the EHR is the medical images obtained over a patient's lifetime and stored in diverse PACS. The vision presented in this paper is that future medical information systems will convert data from various medical sources, including diverse modalities, PACS, HIS, CIS, RIS, and proprietary systems to HL7 standard XML documents. Then, the various documents are indexed and compiled to EHRs, upon which complex queries can be posed. We describe the conversion of data retrieved from PACS systems through DICOM to HL7 standard XML documents. This enables the EHR system to answer queries such as "Get all chest images of patients at the age of 20-30, that have blood type A and are allergic to pine trees," which a single PACS cannot answer. The integration of data from multiple sources makes our approach capable of delivering such answers. It enables the correlation of medical, demographic, clinical, and even genetic information. In addition, by fully indexing all the tagged data in DICOM objects, it becomes possible to offer access to huge amounts of valuable data, which can be better exploited in the specific radiology domain.

Panacea or Placebo? Linked Electronic Health Records and Improvements in Health Outcomes This report to the New South Wales Minister of Health outlines the inherent privacy issues that exist in an electronic health record system, and includes a series of recommendations. Electronic health records are already a feature of the health system in both the public and private health sectors in NSW and their use is increasing. Their wider introduction is inevitable. The primary challenge of this development is to maximise both the protection of individual privacy and positive health outcomes. While the mere existence of electronic health records poses limited privacy risks to the health consumer, this risk dramatically increases when health records in electronic format are linked. An electronic health record residing on a stand alone computer in a general practitioner's surgery or other facility provides minimal opportunities for unauthorised, external access. However, when the stand alone computer is connected, especially via the internet, allowing all or parts of the electronic health record to be exchanged with other health service providers, control over access to and security of the information is compromised. This is the primary privacy concern regarding electronic health records: not that the records are created but the fact the records can be transferred via communication links leaving the health consumer unable to be certain who is accessing their health information. Controls and safeguards over access to electronic health records must be established to ensure that there is maximum public confidence in a health system where transfer of confidential information will become more routine. The NSW Department of Health has in place a Health Information Privacy Code of Practice. The Code applies to personal health information, which is held by: the Department of Health; the public health system; the NSW Ambulance Service; and non-government organisations receiving funding from the Department where compliance is included in the terms of their funding agreements. The Code also applies to any private health care agencies or practitioners, researchers or others who have authorised access to personal information owned by the public heath system. While the Code sets very high standards of practice, the Report of the NSW Health Council found that there are "inconsistent standards about privacy and confidentiality" within the system.

Paths to Better Health: Final Report Advisory Council on Health Infostructure's report on the Canada Health Infoway, the key information and communications foundation for the Canadian health care system. This report is about how new information and communications technologies strategically deployed in a pan-Canadian health information highway (Canada Health Infoway, for short) or infostructure, can help to empower Canadians with better health information and new opportunities. This report is also about how the Canada Health Infoway can help significantly to improve the quality, accessibility, portability and efficiency of health services across the entire spectrum of care. It is also about how the Infoway can enable the creation, analysis and dissemination of the best possible evidence from across Canada and around the world as a basis for informed decisions by patients, citizens, informal caregivers, health professionals and providers, and health managers and policymakers. In the Council's view, the Canada Health Infoway will become the key information and communications foundation for our health care system in the 21st century. It will also become a powerful contributor to improvements in the health of Canadians.

Patient and Provider Health Data Privacy Concerns A look at the privacy concerns that were expressed by participants in the COMPETE study (Computerization of Medical Practices for the Enhancement of Therapeutic Effectiveness), an electronic health project conducted by the Centre for Evaluation of Medicines, an academic research centre affiliated with McMaster University, Hamilton, Ontario. The increasing use of computers and information communications technology (ICT) in healthcare amplifies concern about privacy and confidentiality. The COMPETE study (Computerization of Medical Practices for the Enhancement of Therapeutic Effectiveness) is a community-based electronic health project conducted by the Centre for Evaluation of Medicines, an academic research centre affiliated with McMaster University, Hamilton, Ontario. The 33 family physicians who participated in the study converted their practice, both administrative and clinical functions, to an electronic health record (EHR) system. One of our research objectives was to study health data privacy perceptions of providers and patients.

Patient-Oriented Segmentation and Visualization of Medical Data This German paper examines the PREPaRe (Personal Repository for Electronic Patient Records) system, an EHR that focuses on the patient and is able to process, store, and visualize all types of medical data. The PREPaRe system (Personal Repository for Electronic Patient Records) is a patient-oriented internet-based information system that is able to store, combine, process and visualize all types of medical data that are part of a personal electronic medical record. Focusing on patients as the system's end users results in requirements which are hard to meet and make extensive data preprocessing essential. Extended anatomic information is created from the patient's data and an enhanced anatomic atlas. Based on this information, patient-oriented, disease specific visualization of the patient's anatomy is derived. Embedded into a three dimensional virtual world it provides easily recognizable access to the medical circumstances.

Physician's Weekly One can sign up to receive the free Physician's Weekly e-newsletter that is published every Monday.

Privacy Act The official version of the Act from the Justice Canada site. Must be downloaded in several sections.

Privacy Code Canadian Standards Association presents information on the Privacy Code. This is the first edition of CSA Standard CAN/CSA-Q830, Model Code for the Protection of Personal Information. This Standard was prepared by the CSA Technical Committee on Privacy, under the jurisdiction of the CSA Steering Committee on Business Management Systems, and was formally approved by these Committees. It has been approved as a National Standard of Canada by the Standards Council of Canada.

Privacy Commissioner of Canada The site is comprehensive with many valuable links to the privacy commissioner's findings, descriptions of legislation, broad Canada wide resources, and fact sheets. The Commissioner is an advocate for the privacy rights of Canadians. The Commissioner powers include investigating complaints and conducting audits under two federal laws; publishing information about personal information-handling practices in the public and private sector; conducting research into privacy issues; and promoting awareness and understanding of privacy issues by the Canadian public. The Commissioner works independently from any other part of the government to investigate complaints from individuals with respect to the federal public sector and the private sector.

Privacy of Electronic Health Records Presentations, lecture notes and visual aids delivered at the Federated Press Privacy of Electronic Health Records Course held in Toronto on January 30 & 31, 2002.

Privacy Protection in the Dental Office Canadian article that looks at privacy issues regarding the use of EHRs in dental offices.

Privacy Technology Review The authors summarized privacy requirements in the health sector, based on operational scenarios and the ten fair information practices delineated in the CSA Model Privacy Code. This phase included interviews with OHIH resources, and discussions regarding OHIH's broad concept of an electronic health record. The results are summarized in a table at the end of Section 1, which shows the ten privacy principles, the business rules that each implies, and the requirements that a privacy technology must meet to support the business rules.

PrivacyHORIZON This is a monthly eZine of Health Privacy News.

PrivacyInfo.ca A very good site for researching Privacy Legislation in Canada. There is an effective full-text search engine for searching Privacy decisions. The site features summaries of all of the Canadian Privacy Commissioner's decisions under the Personal Information Protection and Electronic Documents Act (PIPEDA) . While those decisions are available in full-text on the Commissioner's site, this site provides additional search functionality, including full-text searches as well as searching by individual provisions, sector, and outcome. The site also contains links to Canadian privacy legislation, privacy law news, and other resources.

Promoting E-health in Europe: Challenges and Opportunities A series of papers devoted to the development and possibilities for application of e-health in Europe. A great deal of information regarding EHRs is included.

Protecting Privacy and Health Information Information on electronic health records is included in this 1999 brief to the Canadian Standing Committee on Industry on the matter of Bill C-54.

Protecting Your Medical Records Top ten strategies to protect patient confidentiality.

Public Views on the Sharing of Personal Medical and Social Care Information Northumberland Community Health Council, U.K. held a series of seven focus groups, made up of members of the general public in Northumberland, in an effort to create a set of guidelines for developing and implementing electronic health information systems. Patient confidentiality and privacy concerns are considered. Patient confidentiality and the need to safeguard personal medical and social care information is a key concern for the Northumberland Health Action Zone programme "Information for Health". Similarly, the Community Health Council is keen to be involved in formulating guidelines for those concerned with developing or implementing information systems. To assist in the work of Caldicott Guardians in devising local protocols around protecting patient information, it was decided that the views of members of the public in Northumberland should be explored. A series of seven focus groups was held with the aim of collecting a broad cross-section of opinion. A number of health, community and social care interests were represented, with both urban and rural, male and female, younger and older participants. Discussions were around three key themes: with whom people would expect information to be shared; with whom they would be content for information to be shared; and who they would not wish to have access to that information.

Realising the Vision of Electronic Healthcare Records: A Review of the Lessons of the Population Health Summary System Project The Welsh office of the NHS commissioned this report in 1998 on the Population Health Summary System (PHSS) project, whose aim was to improve health care through using a shared distributed electronic patient record and to make the quality of aggregated data for epidemiological, management and planning activities more meaningful. The Welsh Office commissioned this report from Secta in 1998. It has been prepared based on a review of written material from the PHSS project and on discussions with some of the PHSS project staff. It should be seen as a summary of some of the key lessons learnt, and not taken to represent a formal post project evaluation.

Recent Developments in Health Information: An International Perspective This paper provides a comparative overview of health information activities, focusing on the activities of Canada, Australia, and England, as well as giving examples that are drawn from other countries. A selection of good links can be found at the end of the document. This paper provides a comparative overview of health information activities at a national level in selected developed countries world-wide. While the focus is on activities in a sample of major industrialized countries other than the United States (Canada, Australia, and the England), illustrative examples are also drawn from other countries.

Reducing Medical Errors: Applying Just-in-time Knowledge Medical errors have been the object of increasing attention since the publication of the Institute of Medicine report: To Err Is Human: Building a Safer Health System . This report estimated that medical errors in U.S. hospitals account for the equivalent of a 747 plane crash every day. A large hospital could save 30-40 hospital beds per year by decreasing adverse drug event-related morbidity. Healthcare providers are just starting to assess the impacts of medical errors on patient safety and on costs. Early responses include on-line Physician Order Entry systems and the delivery of evidence-based care guidance to the point of care. This seminar illustrates technological advancements focused on reducing medical errors and optimizing the utilization of resources. Medicalis Inc., with Brigham and Woman Hospital (BWH), in Boston, MA, has developed a patented web-based solution that delivers the most current and up-to-date medical information to physicians. The evidence-based information that the physician receives is relevant and specific to each patient interaction. This solution includes a web application for physicians to order tests and review the results, an integration layer that bridges the practitioner s office with the systems of the test-performing institution, and a workflow manager and advice-engine that use relevant knowledge to guide ordering. The presentation addresses clinical and technological issues: physician reaction and willingness to accept such technologies, the bridging of islands of healthcare information, the embedding of knowledge in interactive and complex processes, and the benefits of knowledge management solutions. A demonstration of the technology used at BWH will also be given.

Reporting of Adverse Drug Reactions and Medication Errors This is a useful guide for health care professionals requiring contact information for the reporting of adverse drug events/medication errors. It provides a comprehensive list of national governing bodies. Several national and international reporting programs have been established to allow health professionals and others to report adverse drug reactions and medication errors. Reporting of these medication-related problems serves an important public health benefit, to alert other health professionals of problems so that injury can be prevented to other patients from a repeat of the same problem in the future. All health professionals are encouraged to submit confidential reports to these reporting agencies so that others can learn from these experiences.

Reports and Publications - eHealth A portfolio of full-text reports, bulletins, and articles from Health Canada.

Role-Based Access to Patients Clinical Data: The InterCare Approach in the Region of Crete Greek paper that discusses the basics of an Integrated Electronic Health Record (I-EHR) implementation of HYGEIAnet, the Integrated Healthcare Telematics Network of Crete. The basics of a particular Integrated Electronic Health Record (I-EHR) implementation are presented, as realised by the Patient Clinical Data Directory (PCDD) system. PCDD operates within the context of HYGEIAnet, the Integrated Healthcare Telematics Network of Crete. PCDD is based on a federation of autonomous information systems and provides to its authorized users alternative views of the health record as well as access and retrieval services to its geographically distributed segments. The data model of the PCDD is based on the Subjective Objective Assessment Plan (SOAP) model that originates from the primary healthcare domain. Access to detailed information on particular patients healthcare encounters is delivered via role-based authorization privileges and controls. The administration of the national healthcare organizations' business rules, for different user-groups, is made via a specially tailored and developed rule-editor.

Romanow and Beyond: A Primer on Health Reform Issues in Canada November 2002 discussion paper by Canadian Policy Research Networks (CPRN) that incorporates information about electronic health records. Romanow and Beyond: A Primer on Health Reform Issues in Canada is a primer for those who wish to stay on top of the debate over the future of health care. The authors pull together the major recommendations of commissions and advisory committees in Alberta, New Brunswick, Ontario, Quebec and Saskatchewan, as well as the federal National Forum on Health, the Senate's Kirby Committee, and the Interim Report of the Romanow Commission.

Scottish Executive Strategic Data Sharing Framework The Scottish Executive's 21st Century Government Unit is working with the Department for Constitutional Affairs (DCA) to develop a Public Services Trust Charter that will set out standards of service which citizens can expect from public services handling their personal information. The Executive will develop information for citizens and publicity material to raise public awareness of their rights in relation to the use of personal data. The Statistician Group will develop information covering use of personal data for statistical purposes.

Security in Clinical Information Systems The proposed introduction of a nationwide NHS network has led to concern about security. Doctors and other clinical professionals are worried that making personal health information more widely available may endanger patient confidentiality. The problem is not limited to the NHS; it also concerns clinicians in prisons, immigration services, forensic laboratories and private healthcare. However the NHS network has forced the issues to the fore. It has been generally agreed that the security of electronic patient records must meet or exceed the standard that should be applied to paper records, yet the absence of clarity on the proper goals of protection has led to confusion. The British Medical Association therefore asked the author to consider the risks, and to prepare a security policy for clinical information systems.

Seizing The Opportunity: One Time Federal Investments in Health November 2002 Canadian Medical Association (CMA) submission to the Standing Committee on Finance provides an overview of ACCESS HOME (Accelerating Community Care through Electronic Services) that uses information and communication technology (ICT) to provide care in home and community based settings.

Semantic Interoperability and Communities of Practice The vision of reusable digital learning resources or objects, made accessible through coordinated repository architectures and metadata technologies, have been gaining considerable attention within education and training communities. However, the pivotal role of metadata in this vision --and in more general conceptions of the semantic Web-- raises important and longstanding issues about classification, description and meaning. These issues are of special importance in indexing educational resources, where questions of their application and relevance to particular learning contexts often supersede more conventional forms of access such as author, title or date. This paper will look at the exceptional role that metadata plays on the Web --namely as an intervention of human intentionality and meaning in a context that is otherwise dominated by syntax, protocol, string matches and search algorithms. It will look at questions of semantic interoperability from the perspective of communities and practice, as these are relevant to the Web in general and to its educational application in particular.

Shikoku Electronic Patient Record Network Project Shikoku, Japan electronic health record website has information on system configuration, project organization, and an explanation of the structure of the plan.

Shouldn't Everyone Know What is Being Written About Them? An interesting pilot study in the North East of England, 2002, investigates the issues surrounding physicians providing their patients with copies of the letters they write about them.

Slovenia First in Europe to Launch National Electronic Health Care Card In October 2000, Slovenia launched an electronic health card, the first of its kind in Europe. Some of the problems they encountered were privacy issues and card reader problems. Since October 1st, Slovenia has introduced a personal electronic health care card for all its 1,9 million inhabitants. This card has the primary function to check out whether the patient has a health insurance right. The electronic health care record infrastructure of the Slovenian republic, which constitutes a former part of the federal state of Yugoslavia, seems principally inspired on previous plans, as conceived by DSW, a Dutch health insurance organisation. Slovenia is the first European country to have succeeded in the creation of a national health care card at relatively short notice.

Smart Systems for Health Network Rolling Out to Ontario Hospitals Smart Systems for Health (SSH) is a key component of Ontario Ministry of Health and Long-Term Care's (MOHLTC) information and communications technology strategy, and will enable Ontario's health care providers the ability to share patient health information in a secure environment. The Ontario Hospital eHealth Council, in partnership with Smart Systems for Health (SSH), is pleased to provide you with an update on the progress of the SSH initiative. This is the first of many communications updates to hospitals as continued progress is made in furthering eHealth initiatives in Ontario. Smart Systems for Health (SSH) is publicly-funded and a key component of Ontario Ministry of Health and Long-Term Care's (MOHLTC) information and communications technology strategy. The SSH will enable the secure electronic exchange of personal health information among Ontario's health care providers.

Standing Committee on General Government on the Government of Ontario's Proposed Personal Health Information Legislation (Bill 159) An address to the Legislative Assembly of Ontario, Standing Committee on General Government on the Government of Ontario's Proposed personal health information legislation (Bill 159).

Statement on Personal Health Dimension, Healthcare Information and Management Systems Society Presentation (January 2003) by Pat Wise, Director, Electronic Health Record Initiative, National Committee on Vital and Health Statistics, Department of Health and Human Services, Washington, DC. on the potential and benefits of developing an electronic health records system. Includes a description of the Enterprise Master Patient Index (EMPI).

Strategic Management of an Electronic Patient Record Project Using the Balanced Scorecard Canadian paper on the balanced scorecard framework that allows strategic management of an electronic patient record project. Effective performance measurement links goals to information. It is an integral part of the management process. Organizations have different approaches to providing their management teams with information, ranging from aggregating reports derived from operational systems to explicitly defining a set of key indicators about which data is collected and periodically distributed. Typically, in the latter approach, the emphasis is on standard financial and quality management data defined by corporate staff in those areas. This provides large quantities of useful data, but fails to provide assistance to managers in thinking through their real information needs. Ironically, an excess of data overloads rather than enlightens managers. The scarce organizational resource is not information, it is organizational attention -- the allocation of information processing capability to a defined issue or agenda. Organizational attention is the fundamental constraint in achieving objectives. What managers need is the right strategic information at the right time that can focus organizational attention on agendas linked to strategies.

Sub-Group 5.2 Client Health Card Standards: A Discussion Paper Canadian paper from October 1997 that discusses the benefits of developing a national framework for an electronic health record that incorporates inter-operability.

Supporting Faculty Communities of Practice Using Collaborative Technologies As post-secondary institutions become more virtual and housed in the online environment, questions arise on finding ways to support faculty and their departments. This research project used a case study methodology to look at faculty in three virtual departments in the e-merge project (a provincial initiative coordinating multiple post-secondary institutions in the creation and delivery of online programs) and how collaborative technologies might have influenced their development into communities of practice and provided faculty support. The research project reviewed collaboration, differentiating it from cooperation or coordination and collaborative technologies from collaborative use of technologies. Interviews and survey results were used to develop recommendations, best practices and guidelines.

Sweden's Model of Consumer Choice in Healthcare European governments have struggled to combine their traditional ethos of equity in healthcare with the demands of a more sophisticated, consumer-driven society. Few expected that their inspiration for reform might come from Sweden. Yet this country, known for its deeply-rooted belief in the welfare state, has changed as it has come under pressure from both patients and health service workers. There are links to other articles on Swedish health reform.

SynExML as a vehicle for Electronic Patient Records Researchers from Ireland and Norway use core XML (eXtensible Markup Language) to provide seamless integration of distributed electronic patient records as part of SynEx, a major EU (European Union) Health Telematics project. The advent of shared care coupled with the proliferation of heterogeneous distributed systems containing patient data have resulted in an urgent need to provide seamless integration of distributed electronic patient records. This paper presents the approach to this problem, which is being developed as part of a major EU (European Union) Health Telematics project, SynEx. The approach is based on a core XML (eXtensible Markup Language) DTD corresponding to a flexible common model of the shared - or federated - Electronic Healthcare Record. Using this DTD, SynEx has successfully demonstrated the exchange of records between two heterogeneous and geographically separated sites.

Taking Health Care to the Streets: Ottawa's Inner City Health Project The Inner City Health Project is using electronic health records to help Ottawa's street people. Life on the street is tough. Living conditions in shelters and on the streets constantly expose homeless individuals to extreme weather, infectious diseases and violence. Many individuals who are chronically homeless experience multiple mental and physical health problems, including mental illness and addictions. In general, the mainstream health care system is not set up to deal effectively with their health care needs. In Ottawa, Ontario, an innovative partnership is seeking to change this through the Inner City Health Project.

Telehealth Professional Email Discussion List Telehealth Professional Email Discussion List is a free email list that discusses the international ramifications of telehealth and telemedicine. To subscribe, send a message to: LISTSERV@MAELSTROM.STJOHNS.EDU and in the body of the message type: SUBSCRIBE Telehealth yourfirst yourlastname

The Canadian Institute for Health Information (CIHI) The Canadian Institute for Health Information (CIHI) provides timely, accurate and comparable information. Our data and reports inform health policies, support the effective delivery of health services and raise awareness among Canadians of the factors that contribute to good health. Available in both French and English.

The Canadian Organization for Advancement of Computers in Health (COACH) COACH is an organization dedicated to promoting a clear understanding of health informatics within the Canadian health system through education, information, networking and communication. Canadian organization that uses education, information, communication, and networking to promote understanding and use of information technologies in the Canadian healthcare environment.

The EHR Journey in the UK: Change in Direction? A paper that presents the British view of the EHR system, including the semantic challenges, realities, and expectations of implementation.

The Electronic Health Record: A Pragmatic Definition, What it Means and the Implications A good quick introduction to the factors involved in electronic health records for the novice, with a Canadian perspective.

The Electronic Oral Health Record Interesting American paper discusses the electronic health record and its application to dentistry. This paper presents the history of the use of the computer for maintaining patient medical care information. An electronic record generated with a computer, which is non-specific for any healthcare specialty, is referred to as the electronic health record. The electronic health record was previously called the computer-based patient record. "Electronic" replaced the earlier term "computer-based" because "electronic" better describes the medium in which the patient record is managed. The electronic health record and its application to dentistry are discussed. The electronic health record is a "database" of patient information that has been entered by any healthcare provider; the electronic oral health record is an "electronic record" of oral health information that has been entered by an oral healthcare provider. The significant differences between the electronic health record and the electronic oral health record are outlined and highlighted. Included is a template describing a procedure to be used by dental personnel during the decision making process of purchasing an electronic oral health record. A brief description of a practice template is also provided. These completed templates can be shared with dental software vendors to clarify their understanding of and to clearly describe the needs of today's dental practice. The challenge of introducing information technology into educational institutions' curricula is identified. Finally, the potential benefit of using electronic technology for managing oral healthcare information is outlined.

The Endangered Medical Record This report offers insight into how both patient care and biomedical knowledge are threatened by the healthcare system with its "code-dependent" technology. The honesty, accuracy, and completeness of the medical record are threatened by today's healthcare system and crippled by our "code-dependent" technology. The result is declining quality of care, increased costs, and a public policy often built on sand. The medical record is the key document for personal health care. We assume that our medical records provide faithful and complete memory for our physicians and for communication among all the caregivers. Increasingly this assumption may not be correct. Medical record information has many secondary uses billing for our care and developing statistics for many purposes, ranging from clinical research to national health policy development. Each use requires the proper information. The entire information system is code-dependent. Information is captured as codes and retrieved via codes. The codes must be able to give us what we need.

The European Healthcard: The Time to Legislate is Now The European Union for years has considered introducing a healthcard that citizens of all Member States could carry to help facilitate the provision of health care throughout the EU. Such a card would ensure that care providers in all Member States could access the medical information of those patients who do not reside in the country where care is being provided. In the wake of the EU's failure to introduce such a card, many Member States have developed their own incompatible healthcard technologies. The EU must implement a universal healthcard in the near future in order to prevent the further development of technologically advanced but functionally incompatible healthcard systems.

The Evolution of Electronic Medical Records The author describes the benefits of the electronic medical record and also the problems that must be solved in order to integrate them on a regional, national, and international level via the Internet. No clinical computing topic is being given more attention than that of electronic medical records. Health care organizations, finding that they do not have systems adequate for answering questions crucial to strategic planning and for remaining competitive with other provider groups, are looking to information technologies for help. Many institutions are developing integrated clinical workstations, which provide a single point of entry for access to patient-related, administrative, and research information. At the heart of the evolving clinical workstation lies the medical record in a new incarnation: electronic, accessible, confidential, secure, acceptable to clinicians and patients, and integrated with other, non-patient-specific information. The author describes the problems associated with paper-based record keeping and the promise of the electronic medical record, emphasizing the areas of clinical trials and decision support. He then discusses the issues that must be addressed and the requirements that must be met if electronic medical record systems are to move beyond intranet environments within single health systems or practices and to integrate with regional, national, and international resources via the Internet.

The Informatics Review The Informatics Review is a electronic serial designed to allow busy medical and information system professionals interested in the latest academic developments in clinical informatics and computing to stay abreast of this rapidly evolving field.

The Mantra of Modeling and the Forgotten Powers of Paper: A Sociotechnical View on the Development of Process-oriented ICT in Health Care This paper from the Netherlands argues that a reinterpretation of the ICT 'models' concept needs to take place in the development of an EHR system because modeling should be seen as an intervention in the organizational change-process that constitutes proper ICT development. The recognition that restructuring care processes is central to effective and efficient health care will result in the emergence of process-oriented electronic patient records (EPRs). How will these technologies come into being? Within informatics, it is often stated that to informate something, we should first model it. This paper queries whether a detailed modeling of work processes and data flows is the primary step that needs to be completed before such EPRs can be developed or tailored. Building upon a sociotechnical understanding of ICT development, we argue for a reinterpretation of 'models' in such development processes. We do so through a reverse engineering of parts of the paper-based medical record, which has received little attention in medical informatics. In process-oriented EPR design, we argue, modeling should not be conceived as the crucial first step in this design, but rather as an intervention in the organizational change-processes that constitute proper ICT development.

The Missing Link This is a full-text article from 2002 Canadian Healthcare Manager magazine.

The National Health Database The purpose of creating a National Health Outcomes Database is to provide information about experience with a course or courses of treatment, tailored to those demographic and clinical characteristics of patients that are known to influence the outcomes, and to help patients and their physicians make treatment decisions that lead to the best outcomes given patient preferences. This process can occur by making information readily available about the experience of different courses of treatment - whether drawn from clinical trials, treatment registries, or surveys - stratified by key patient characteristics. Depending on the condition selected, the way in which the outcomes database is built may differ (i.e., a newly created registry versus combining existing databases from clinical and observational, following a cohort of patients who have faced a treatment decision and chosen (or had chosen for them) one of several available treatments (including watchful waiting). Once the information is gathered and organized, the information then must be presented in formats that can assist patients and clinicians with understanding the state of knowledge regarding different treatment courses for the selected health conditions and patient experiences with those treatments.

The Patients Association The Patients Association is a registered charity, staffed by paid and unpaid staff. The Patients Association offers patients an opportunity to share their experiences of health services. The Patients Association uses the knowledge it gains from patients to work with the NHS and other healthcare providers to improve services. The Patients Association works with a range of organisations providing health services and receives income from Corporate Members in the commercial sector, specific project work, consultations and from events. The Patients Association does not receive a grant from The Department of Health or any other government body.

The Potential Impact of Home Telecare on Clinical Practice Home telecare is the use of information, communications, measurement and monitoring technologies to evaluate health status and deliver healthcare from a distance to patients at home (Box, Figure 1). In the United States, home healthcare is the fastest-growing healthcare delivery sector1,8 -- more than 5.9 million Americans received home healthcare services valued at more than $US25 billion in 1996. Only about 50 of almost 1800 US home care agencies are currently active in home telecare, but, driven by changes in healthcare provision and reimbursement policies, many more are participating in trials of cost effectiveness; home telecare is expected to grow dramatically. Outside the US, the move towards telecare is being driven by the acceptance that national health services have a responsibility to manage the needs of an ageing population.2,9,10 People aged 65 years and over now represent 12% of the Australian population,11 a figure which will increase to 25% by 2051. Furthermore, average healthcare expenditure per person is currently $2536 per year, but increases almost tenfold for those aged 75 years and over. The increasing cost of providing healthcare services to an ageing population and changing patterns of use of hospital resources (a rise in admissions but a fall in the average length of stay) are powerful forces for shifting the focus of care from the hospital to the home.

The Unified Electronic Patient Record Project (UEPR) Description of the Unified Electronic Patient Record Project (UEPR), Brazil.

Tools of Change: Proven Methods for Promoting Health and Environmental Citizenship This Web site, founded on the principles of community-based social marketing, offers specific tools, case studies, and a planning guide for helping people take actions and adopt habits that promote health and/or are more environmentally-friendly. This Web site will help you include in your programs the best practices of many other programs - practices that have already been successful in changing people's behaviour.

Towards a Multi-Professional Patient Record Swedish paper that describes a national project to develop a multi-professional database of terms for the health care sector, and reports on the differences and similarities of headings used in patient records by Swedish health care professionals. This paper reports on the differences and similarities of headings used in patient records by Swedish health care professionals; nurses, occupational therapists, physiotherapists, dieticians, speech therapists, medical social workers and general practitioners. The background to the study is a national project where representatives from the different health care professions have worked together for two years in an effort to develop a multi-professional database of terms for the health care sector. The study reports on an analysis of the existing multi-professional lists of headings with respect to structure, degree of specialization, synonyms and homonyms. The study is descriptive in nature, gives a status report on the variety of headings used in clinical practice, provides necessary material for a normative approach focusing on a truly multi-professional patient record in the future.

Towards an Evaluation Framework for Electronic Health Records Initiatives: A Proposal for an Evaluation Framework An Electronic Health Record (EHR) provides each individual with a secure and private lifetime record of their key health history and care within a health system. The record is available electronically to authorized health care providers and the individual anywhere, anytime, in support of high quality care. Recognizing the importance of the EHR in improving the quality and efficiency of health care, the federal government of Canada, in 2001, established Canada Health Infoway to support and accelerate the development and adoption of interoperable Electronic Health Records solutions across the country. Four core components have been identified as the key building blocks of an EHR by Infoway and the Newfoundland and Labrador Centre for Health Information (NLCHI): (1) a unique personal identifier/client registry; (2) a pharmacy network; (3) a laboratory network; and (4) a diagnostic imaging network.

U.S. Air Force and UPMC Receive Federal Funding for Integrated Medical Information Technology System January 2002 article that calls a seamless electronic health record implementation a key feature. In a benchmark collaboration between an academic medical centre and a branch of the United States military, UPMC Health System and the U.S. Air Force Medical Service (AFMS) will work to develop sophisticated telemedicine technology which will ultimately link specialists in pathology, radiology and dermatology with outposts at distant locations around the globe. The partnership, which was made possible by an $8.5 million appropriation in the defence spending bill for 2002, brings together vast clinical and information technology expertise and will aid in the recognition and treatment of many types of medical conditions, including those caused by chemical or biological agents.

Undermining Data Privacy in Health Information New powers to control patient information contribute nothing to health. Since 1910, doctors have been arguing with successive British governments over access to medical records. The compromise that has emerged over the years balances patient privacy, professional autonomy, public health effectiveness, and the needs of scientific research. Past attempts to disturb this balance have foundered on professional resistance, patient rights, and the property rights of healthcare firms but the side effects of these disputes have often been debilitating. And now an innocuous sounding clause in the latest bill on health is set to upset the balance again, with potentially damaging effects on both privacy and research. Bibliography with links.

Understanding the Paper Health Record in Practice: Implications for EHRs Many discussions about the limitations of paper records and the potential of electronic health records carry with them an implicit conceptualisation of the "record as passive information archive." This paper reports on a qualitative study of a hospital medical unit that looks instead at the paper health record "at work." While accepting the well-documented limitations of the paper record, this study highlights some of the subtle yet critical ways that this working record is an integral part of the practical doing of healthcare. Firstly, there is no such entity as the health record in practice -- the working record is an evolving set of complexly interrelated forms, papers and documents that are embedded in the social, spatial and organisational milieu of the hospital. Further, the tangible physical nature of the record allows for flexible use, supports local preferences, enables overlaid functionality and conversations at the point of work, helps make work visible to others, is easy to move around, and supports timely responses to needs. Based on these findings, I suggest that the design of technology for healthcare should start with the question "how do we support clinical practice," which requires that we understand more about the realities of that practice. I go on to draw out implications for the types of technologies that could help support clinical practice when paper records are no longer used.

Western Health Information Collaborative The Western Health Information Collaborative (WHIC) is a process initiated by the Western Premiers and Deputy Ministers of Health to explore collaborative opportunities with respect to health infostructure initiatives. This collaborative has explored common opportunities that meet western provinces and territories health information needs and support the strategic directions and initiatives for health infostructure at the national level. WHIC is basically about doing better together.

What is an Electronic Patient Record? Sunnybrook Health Science Centre paper describing a model that clarifies the relationship that exists between the electronic patient record, the paper chart and multiple clinical information systems. While organizations develop their Electronic Patient Records, there will be a transition period during which computerized and paper records will both exist, possibly on multiple clinical information systems. This paper describes a model that defines the patient system of record and its constituent paper elements and electronic components. The model has been adopted by a large academic health science center for their development of an electronic patient record. The model has clarified which systems and data constitute the patient system of record and the standards and policies that apply to these systems.

What is Wrong with EMR? Researchers from Canada and the United States take a look at the functionality of electronic medical records and debate its future. An ideal EMR should be able to provide complete, accurate, and timely data, alerts, reminders, clinical decision supports, medical knowledge, communications, and other aids at all points of care for all healthcare professionals at all times in a way the quality of healthcare can be dramatically improved. However, these promised functions are far from being realized in current EMR, and the resistance to current EMR from healthcare professionals is still strong. Will these promised functions ever be realized? Will EMR ever be accepted universally by healthcare professionals? What is wrong with EMR? The participants of this panel will identify and debate the fundamental problems of current EMR, and they will make recommendations that could potentially make EMR closer to its promised functions. In their view, although from different perspectives, an ideal EMR is not impossible. To achieve its promised functions, however, the first goal that has to be satisfied is that an EMR must be usable.

Which Rules? Integrating Different Tools in a Global Perspective Paper given by Malcolm Crompton, Federal Privacy Commissioner, Australia, at the 22nd International Conference on Privacy and Personal Data Protection, 27-30 September 2000, Venice. Information on electronic health records is included in this document.

Working Group 1: Health Information Model, 1996 Canadian Institute for Health Information background document prepared for Working Group 1 (Health Information Model) of the Partnership for Health Informatics/Telematics focuses on health information models that include the areas of electronic health record architectures and other standard architectures used for health information systems.

Working Group 3: Privacy, Confidentiality, Data Integrity and Security The Canadian Institute for Health Information report from 1997 gives an overview on privacy, confidentiality, data integrity and security in connection with managing and exchanging health information electronically. The document covers recent international developments and issues in Canada.

XML in Healthcare Computing the Potential From time to time there is a landmark development that revolutionises the way that we live, the things we do and the way in which we do them. One of the most significant developments of the last part of the last century was the computer. In previous centuries, the book (paper) had an equally significant impact. Both are currently used for the recording of clinical information. Will XML finally allow the computer to replace paper in the recording of clinical information? Will XML itself be considered a landmark development?

XML: Technical Overview and Applications for HL7 The authors of this technical report offer solutions in the form of a Patient Record Architecture to the problems inherent in the non-standardized electronically inaccessible system that constitute and plague healthcare systems.