Smart systems help you manage your health online

The government agency behind linking all health care providers in Ontario through a dedicated network plans to recruit hesitant physicians, consolidate information, and allow citizens access to their records from home in the next five years, according to an announcement.

The Toronto-based Smart Systems for Health Agency (SSHA) marked their five-year anniversary by proclaiming their objectives for the next five years.  The agency’s mission is the creation of an Electronic Health Record for every Ontarian.

To accomplish this, the agency has juggled various vendors in all shapes and sizes to create the Ontario Network for e-Health (ONE). The network allows mail between users and hosts 15 applications.

It’s been adopted by every hospital in Ontario from Ajax to Zephyr and has reached 13,500 people located at 5,000 different sites. But with only eight per cent of physician offices connected, growth isn’t moving fast enough, according to Bill Albino, chief executive officer for SSHA.

“I’d like to see it go much faster,” Albino told ITbusiness, “the sooner the electronic medical record is adopted right across the system, the better off we’ll all be.”
Part of convincing more doctors to climb on board ONE is creating bulletproof network access control methods that are appropriate for the sensitive nature of private health information, he adds. ONE needs to be easily accessible for health care workers, but highly secure.

“We are constantly watching the network for intrusion,” Albino says. “With networks of our size, it does happen, but there’s people watching at all times to make sure it is secure.”

To protect their province-wide IT infrastructure, SSHA uses a Authentication, Authorization and Audit (AAA) data management system. Physicians get on the network the same way they get  their golf club memberships – through a third-party reference.

A seven-character, case-sensitive password requires an alpha character for extra strength. Session times are limited to make sure valuable information isn’t left on screen.

“We try to make sure the users who are getting on are the right users. We are very vigilant about that,” Albino says.

Security and air-tight access control is key as SSHA works toward allowing Ontarians access to their own health record to view, manage, and control whom and who can’t see the information. The agency faces the same challenges as Google Health and Microsoft HealthVault, analysts say.

Security is a big concern,” says Ross Armstrong, senior research analyst with London, Ont.-based Info-Tech Research Group. But “from a business perspective it makes sense to have records available online.”

To that end, SSHA took responsibility at the beginning of the year for the Master Patient Index (MPI). The index will take information from different hospitals and physician sites and crunch it down into one location – all critical information for the network are housed on two mirror datacenters in Markham and Streetsville, Ont.

“When a patient has a deadly disease, and that information has to get to the correct physician and the correct patient, you can’t afford mistakes,” Albino says.

There are over 400 John Smiths in Ontario, the CEO gives as an example. That means a program is required to use an analytical algorithm to decide what different records at different institutions belong to the same person. The program compares variables such as date of birth, health card number, etc.

MPI “is pretty crucial for a foundation of a sharing method between providers,” Armstrong says. But having all of a patient’s information stored in one digital place means the network requires 100 per cent up time.

“Over a long enough timeline the certainty of an outage becomes an absolute,” the analyst says.

That’s a reality SSHA got a taste of when 330 sites lost service Jan. 16. A firewall upgrade intended to allow remote access caused a conflict with clients using ADSL connections and a clinical management system (CMS). Many sites were off the network for four business days, and SSHA had to dispatch support to many locations.

“Generally having a CMS is a very reliable system,” Albino says. “But they have a need to be online all the time.”

SSHA learned from the outage experience, Albino adds. They replaced all the ADSL circuits with a more reliable T1 connection. They are also working to guarantee at least some network connectivity for sites during future outages.

Outages aside, SSHA has a difficult task ahead, Armstrong says. The agency is taking on a gigantic IT project that is unique and bound to face obstacles along the way.

“It is difficult enough to amalgamate all the systems in one hospital, let alone all of Ontario,” he says.

With the near-term goal of a single sign-in system, SSHA is hoping to attract more physicians to ONE, says Albino. All information should be accessible from a single point, instead of spread across different systems in a hospital, or on the regional, provincial and national levels.

As if organizing e-Health for Ontario weren’t enough of a challenge, SSHA is also set to support a new agency that will handle information related to the outbreak of disease and infection. Panorama is the project to track outbreaks at the national level.

Panorama will help to identify where outbreaks occur, how well they’re being controlled, where vaccines are available and at what rate they’re being dispersed, Albino says.

That system is expected to go live this year.

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