Pharmahorizons Lifetrack

Volume 8 Issue #2 - March 2007

Story 1:

Emergis signs contract to deploy EHR across Montreal

The hospitals included in the announcement include: l’Hopital Maisonneuve-Rosemont, l’Hopital du Sacre-Coeur de Montreal, l’Hopital Sainte-Justine, l’Institut de cardiologie de Montreal (Montreal Heart Institute), Sir Mortimer B. Davis Jewish General Hospital and St. Mary’s Hospital Centre.

Already installed in the eight hospitals or institutes representing the McGill University Health Centre and Centre hospitalier de l’Universite de Montreal, the Oacis EHR system will help improve the quality of patient care in hospitals across the Montreal region.

The Montreal-region hospitals where Oacis is already installed include those of Centre hospitalier de l’Universite de Montreal (l’Hotel-Dieu, l’Hopital Notre-Dame and l’Hopital Saint-Luc, and those of the McGill University Health Centre (the Montreal Children’s Hospital, Montreal General Hospital, Royal Victoria Hospital, Montreal Neurological Hospital and Montreal Chest Institute.

L’Agence de la sante et des services sociaux de Montreal (l’Agence) is administering a single regional contract for the current and subsequent phases of this major, multi-million dollar project.

“Our top priority is the delivery of quality healthcare to the 1.8 million people in the Montreal region. After an evaluation of available EHR alternatives and its approval by the hospitals involved, Oacis was chosen as the best solution for both clinicians and patients, and for its ability to interoperate with other systems,” said David Levine (pictured), President and Director-general of l’Agence.

“The installation of this system is a key step in the creation of an integrated health network, providing clinicians with real-time access to patient information across the region,” Mr. Levine continued. “It is already providing benefits within the two Montreal university health centres, leading to enhanced quality of care, better clinical outcomes and lower overall cost.”

“The Montreal-region contract is a major move forward in the execution of Emergis’ EHR strategy,” said Francois Cote, President and Chief Executive Officer of Emergis. “It is a strong endorsement of Oacis as the leading Canadian EHR system on the market today. We are very proud to be part of this major undertaking to improve overall patient care in the Montreal region.”

The installation of the full suite of Oacis web-based products across the region will begin in the spring of 2007. Under the terms of the contract, Emergis will provide the professional resources required for the implementation of the system based on the needs of l’Agence.

Oacis modules to be installed include: a clinical viewer, which enables clinicians to quickly access the patient’s on-line record from any secure Internet connection; an order management capability to provide more informed decision-making, reduce medication errors and increase patient safety; and online clinical documentation modules to record clinical observations and create clinical notes, resulting in a significant reduction in handwritten information and the electronic transformation of clinical processes.

About Oacis
Oacis is an interoperable EHR solution that addresses all aspects of patient record-keeping to support patient management as well as clinical care. An interoperable EHR solution allows clinicians from multiple health delivery institutions to view and update an integrated patient health record, which includes demographic, diagnostic imaging, drug, laboratory, infectious disease, immunization and other relevant health information anywhere, any time. It ensures that caregivers have access to complete, accurate, and up-to-date patient records across geographic regions and within multiple health care organizations, which often have different information systems. The Oacis solution supports health care professionals with collaborative tools which permit better informed decisions, driving improvements in the quality of care and patient outcomes and improved patient safety. Already installed in hospitals in Canada, the United States and Australia, Emergis expects to expand its client base in other geographic areas.

About Emergis
Emergis is an IT leader in Canada that focuses on the health and financial services sectors. It develops and manages solutions that automate transactions and the exchange of information to increase the process efficiency and quality of service of its clients. Emergis has expertise in electronic health-related claims processing, health record systems, pharmacy management solutions, cash management and mortgage document processing and registration. In Canada, Emergis and its subsidiaries deliver solutions to the main insurance companies, top financial institutions, government agencies, hospitals, large corporations, real estate lawyers and notaries and approximately 40% of all pharmacies.

Reprinted from Canadian Healthcare Technology

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Story 2:

Quebec plans to allow prescription drug prices to rise for the first time since 1994.

Health Minister Philippe Couillard says the change could happen as early as spring. The province is the only jurisdiction in North America where prices have been frozen. He denied a report in La Presse that Quebeckers taking part in the government’s drug program will have to absorb increases if drug prices rise faster than inflation. © Canadian Healthcare Technology

Mixed reaction to Quebec's drug announcement
by Alexandre Daudelin

Despite last week's headlines, Quebecers should not be concerned about the lifting of the price freeze on prescription drugs announced by Health Minister Philippe Couillard. At least this is the opinion of Bertrand Bolduc, former president of BioQuébec, Quebec’s biotechnology industry association.

According to Bolduc, the difference on the bill will be small. The price control mechanisms and the market competition between the pharmaceutical companies are going to play a role in reducing the increase.

Within the next month, Quebec should announce a 3-year agreement with the pharmaceutical companies whereby the price of drugs listed in the Régie de l'assurance maladie's formulary can be increased to the level of inflation. The increase will be absorbed by the public prescription drug insurance plan, under which 3.2 million Quebecers are covered.

For its part, the Quebec Association of Owner Pharmacists (AQPP) maintains that, because of the price freeze, which has been in effect since 1994, some products are no longer available in Quebec, although they are available elsewhere in Canada. According to the AQPP, if the price freeze policy is maintained, other products might become unavailable in Quebec.

The AQPP has also indicated that it is concerned that patients would be hit with increased drug prices if the pharmaceutical companies decide to implement a price hike greater than the rate of inflation. This means that if a manufacturer and the government fail to reach an agreement on the price increase for a given product, the manufacturer can implement a price hike just the same, but the difference between the rate of inflation and the manufacturer’s price increase would be passed on to the patient. Patients will certainly not be pleased with this.

Yves Dupré, executive director, for Quebec, of the Canadian Generic Pharmaceutical Association, deplores this decision, as it will inevitably lead to a price increase. "The government is talking about increases tied to inflation, that is, about 2% a year, but I'm afraid that it’s going to be more than this, since the brand-name pharmaceutical companies were already asking for 8% two years ago. Therefore, there’s reason to be concerned."

Adds Dupré: "It remains to be seen how the mechanisms that are going to be put in place are going to work for controlling price increases. Will these mechanisms apply to all drugs? At the end of the day, it's ordinary people who are going to pay the difference, mainly, those aged 50 and over, who use more medications."

For her part, Johanne Brosseau, senior adviser with Aon Consulting, feels that prices will increase at least by the rate authorized by the minister and possibly more, since, unlike the RAMQ, private plans cannot subtract the differences paid by insured persons from the calculation of the maximum annual contribution of $881 or cover less than 71% of the amount claimed, especially when a less expensive generic drug is available. She adds that "the RAMQ will take advantage of the amounts paid by the manufacturers to the government to absorb the price increases due to the price freeze being lifted".

Lastly, for its part, the pharmaceutical industry lobby group, Rx&D, declined to comment on this issue for now, preferring to wait to see what develops.

To comment on this story, email alexandre.daudelin@rci.rogers.com.
© Canadian Healthcare Technology

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Story 3:

Pilot to study use of GPS in diabetes care

This pilot system provides automated and accurate monitoring of a person’s daily activities, travel and exercise.

Led by Sean Doherty, associate professor of geography and environmental studies at Laurier, and Paul Oh, MD, from the Toronto Rehabilitation Institute, the pilot project is supported by a grant from the Canadian Institutes of Health Research (CIHR) and The Health Technology Exchange (HTX), as well as the expertise of several key technology partners.

These technology partners are: RIM BlackBerry, Standard Register’s ExpeData, Life:WIRE, Medtronic and TELUS.

The system uses commonly available GPS-enabled handsets, secure wireless technologies and a specially developed software application that aggregates all the data into meaningful information for the physician. “We all know that exercise, heart rate and diet are important factors in successful management of a diabetic patient’s condition,” said Dr. Oh.

“We anticipate that this GPS-supported monitoring and alerting system will place greater control of health management in the hands of the patient,” he continued. “At a minimum, it will allow individuals to gain a greater appreciation of the effects their work, travel, recreation and eating habits have on their health.”

Approximately 50 patients are expected to participate in the 90-day trial, which will involve monitoring each patient’s daily activities over a three-day period.

“The heart of the system is the software application, which takes a trace of a patient’s GPS location co-ordinates at regular intervals as input, and then provides as output a detailed and highly accurate report of the patient’s activities and trips by start/end time, activity location, mode of travel, environment and other attributes,” said Doherty. “This essentially adds key ‘when’ and ‘what’ attributes to the existing ‘where’ capabilities of GPS technology, with minimal burden to the respondent.”

When combined with physiological monitoring – including blood glucose, heart rate and food intake – the system provides an opportunity to assess the impacts of spatial-temporal daily behaviours on health. Web-based retrospective analysis tools for patients and caregivers have also been developed, including automatically generated activity/exercise/food diaries and interactive maps.

The system combines multiple technologies to provide a comprehensive, yet easy-to-use, automated patient data collection solution which requires very little input from the patient. The following technological components are being used:

• Medtronic’s Continuous Glucose Monitoring System (CGMS), a sensor and monitor that logs blood glucose levels every five minutes for up to 72 hours.

• Bluetooth-enabled heart rate monitor and three-axis accelerometer communicates directly to a BlackBerry device.

• Standard Register’s ExpeData Digital Writing Solution captures handwritten dietary logs with a digital pen and transfers the information to a Bluetooth-enabled BlackBerry handset.

• Life:WIRE’s interactive application allows for remote notifications to gather and analyze data and present results via the mobile device or Web interface.

• BlackBerry handsets provide GPS location information and securely transmit all the data over the TELUS network.

The low participant burden with this system, combined with the accuracy of Web-based reporting and wide availability of GPS-enabled BlackBerry handsets, are expected to make this monitoring and alerting system widely accessible and acceptable for a variety of future healthcare applications.

About Standard Register
Standard Register has been helping clients improve their business processes for almost 100 years. Understanding where the information goes, who uses it and how it is being used are fundamentals of good document design, both for paper-based and electronic workflows, a Standard Register core competence. ExpeData Digital Solutions is a division of Standard Register focused on improving business processes using digital pen and paper technology. More information is available at www.standardregister.com and www.expedata.net.

About Medtronic
Medtronic, Inc. (www.medtronic.com) headquartered in Minneapolis, is the global leader in medical technology, alleviating pain, restoring health and extending life for millions of people around the world. The Diabetes business at Medtronic (www.minimed.com) is a world leader in diabetes management. The company’s products include insulin pump therapy, continuous glucose monitoring systems, related disposable products and diabetes management software.

About BlackBerry/RIM
The BlackBerry and RIM families of related marks, images and symbols are the exclusive properties and trademarks of Research In Motion Limited. RIM assumes no liability and makes no representation, warranty or guarantee in relation to third party products or services.

About Life:WIRE
Life:WIRE (www.lifewire.ca), based in Toronto, is focused on simple and cost-effective solutions for individuals to proactively manage their disease and health conditions through use of standard, off-the-shelf mobile devices as an interactive health management tool. Life:WIRE helps build positive health management habits with interactive reinforcement through a user’s mobile device by sending reminders, allowing users to log their specific data remotely and providing quick response/analysis of the data to the individual and caregiver group.

About TELUS
TELUS is a leading national telecommunications company in Canada, with $8.5 billion of annual revenue and 10.5 million customer connections, including 4.9 million wireless subscribers, 4.6 million wireline network access lines and 1.1 million Internet subscribers. TELUS provides a wide range of communications products and services including data, Internet protocol (IP), voice, entertainment and video. For more information about TELUS, please visit www.telus.com.

Reprinted from Canadian Healthcare Technology

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Story 4:

SSHA riddled with problems, operational review finds

According to Deloitte Consulting, which conducted the review, the value of SSHA’s accomplishments against a $458 million investment over the last four years (including the current year plan) is difficult to assess.

Nevertheless, the 100-page operational review asserts that SSHA could and should play an important role in Ontario’s eHealth strategy. It also emphasizes, however, that major improvements will be necessary before Ontarians can be assured that investments in the agency are resulting in value-for-money.

The following text consists of extracts from the report, which can be found at www.ssha.on.ca/main.asp.


Key Findings

SSHA has been operating in a fluid and complex business environment without formal strategic direction from the Ministry. As a consequence, it has been unable to develop a concrete and detailed strategic plan. This situation has made it difficult for SSHA to establish its business priorities and to meet client and stakeholder expectations. Despite these issues there is overriding support within the broader healthcare community for a provincial agency such as SSHA, dedicated to providing eHealth solutions. In fact, the need for an effective eHealth Agency is expected to increase in the emerging eHealth strategy.

Consultations with clients and stakeholders determined that the SSHA brand is not well regarded. Much of the client dissatisfaction with SSHA’s service is warranted, although the Agency has also faced criticism about issues that fall outside of its mandate. This is a reflection of the nebulous understanding about SSHA’s role and core business within the broader healthcare community. Clients and stakeholders do not distinguish the Agency from the Ministry especially since the Ministry acts as funding provider, oversight manager and client. The broader healthcare community has a range of views on the role that an improved SSHA should play. The spectrum of roles spans from strictly a secure infrastructure provider to a full-service Electronic Health Record (‘EHR’) developer, integrator and operator. The brand and reputation of SSHA can be improved over time, but only through a more disciplined adherence to fewer approved priorities. SSHA can no longer attempt to be ‘all things to all people’ in the eHealth sector, and at the same time deliver on key commitments.

SSHA has not demonstrated its value proposition to clients. The initial infrastructure deployment by SSHA has been complete since 2003. The Agency has been slow to shift its focus from deployment to operations and service excellence. It has not articulated a standardized product and service catalogue with associated pricing that can be compared to the market. The scope expansion inFY04/5 from seven priority areas to the inclusion of client business solutions has tested the capacity of the organization. It has eroded focus on achieving operational excellence within its core products and services. The result has been an unfocused array of clients, products and services that reflect a legitimate desire to utilize deployed assets, but lack a clear commitment to client service and outcome measurement. In a client focused organization, stakeholder committees and user groups would be formed. Client relationships would be supported by service-level agreements (SLAs) and performance reporting.

The advantages afforded by an agency construct have been diminished by SSHA operating more as a Ministry division than an independent operating entity. The current legislation (Regulation 54/05) under the Development Corporation Act restricts the Agency to Ministry-based annual funding as part of the Results Based Planning (‘RBP’) cycle used by the Province. This leaves the Agency susceptible to operational and tactical direction from the Ministry that blurs overall accountability for results. Revenue collection from other sources is prohibited under the Act, yet opportunities exist for joint funding, or cost recovery of services that are being left unrealized. Enabling legislation specific to SSHA is required to support a multiyear funding model with an annual accountability agreement, allowing SSHA to operate more like a transfer payment agency than a division of the Ministry.

The Agency has made significant progress in addressing its founding mandate and business purpose, namely the introduction of secure networks and data centres. However, there is a considerable way to go before value will be realized from the enabling infrastructure. SSHA has installed over 1,700 circuits to connect public hospitals, CCACs, public health units, physicians, and other provincial healthcare providers. The Agency has provisioned two data centre facilities. The result is an ability to host its current 19 applications in a highly available environment. However, significant questions exist relating to the effectiveness of certain decisions and the value obtained from significant investments.

The Agency has faced substantial challenges with respect to the rate of user adoption as well as security architecture methods and expectations. Adoption of secure email as a means of transmitting electronic health information has not met Ministry and SSHA expectations. Of the 60,000 secure email boxes that have been installed since 2003, only one-third mailboxes are in active use. The Agency does not report on whether the sites in use are for the purposes intended, and has not established a position regarding the future of this program.

Similarly, there are issues to overcome with respect to access to a secure eHealth environment. The initial vision of PKI certification of end users has proven to be problematic (e.g., only a fraction of the initial investment has been deployed). In order for the province to leverage value from its investment in a secure eHealth environment, issues regarding user adoption and security will need to be addressed. There is a need to incorporate the lessons learned from previous investment decisions into future plans.

Since cost information by product, service or client has not been maintained historically (nor has performance measures) it is not possible to assess the cost/benefit of past investments. It may also be too early to assess the value of these investments as the healthcare sector has been slower to adopt electronic information management than other sectors. Management recently identified several areas where performance must be improved to ensure control over operational, financial and client service practices. The Agency has also identified the need for substantial performance improvement in its core business of network and data centre operations. However, progress in these areas has been too slow.

The current financial management regime is inadequate to ensure the cost-effective execution of a $145 million expenditure plan for FY06/7. The primary concern is the lack of an effective, centralized, controllership function required to instill financial discipline, control and education across the Agency.

Financial management practices have been inadequate to manage the increasing size and complexity of the organization. We did not find evidence of inappropriate use of funds, although it was not part of our mandate to conduct a detailed review of financial controls. While recent improvements have been made, strengthening SSHA’s management and accountability will require the elevation of financial management on the corporate agenda. In response to these challenges, the Agency will be adding the position of Chief Financial Officer (CFO) to the executive team.

The Agency faces management, performance and organizational capacity issues which must be addressed in the short term. SSHA lacks the rigorous operational and financial planning required to function effectively. In October 2005, the Agency began to implement a new planning process and to develop its first integrated project plan. A resource planning and forecasting process was introduced in October 2005, but has not yet evolved to a consistent, repeatable, Agency-wide process.

Project management capability is insufficient given the complexity of the eHealth field. There is still no single, integrated project management methodology across the organization. The organization structure also needs to be strengthened. The current structure is unnecessarily complex and does not reflect leading practices for Information Services providers.

At the request of the Ministry, SSHA has also been dealing with a transition from a consultant-based to an employee-based organization. Because this transition took place in parallel with capacity building activities, SSHA had difficulty managing the significant degree of change and acquiring appropriately skilled staff. This has led to a skills gap in some areas such as business and financial management. Fundamentally, the culture of the organization needs to change to one that is customer focused, deliverable-oriented, and able to partner effectively with the Ministry and other health sector stakeholders.

SSHA does not have a clearly defined strategy. SSHA does not have an overarching documented strategy that defines the organization’s development over the next 3-5 years, including its strategic goals and objectives. The business plan, with divisional goals and output-based accomplishments, is a mechanism for obtaining annual funding, and cannot be used as a substitute for a comprehensive strategy.

Recently the SSHA Strategic Planning and Communications Committee, led by the Board Chair, submitted a short-term proposed strategy and plan to the Ministry. While this initiative is a good first step, the current status of this proposed strategy remains unclear as it is not formally approved by the Ministry. Therefore, the overall strategic direction for SSHA remains unclear. As such, maintaining focus will continue to be a challenge for the organization. Until a stable, clearly articulated eHealth strategy is defined and approved by the Ministry, SSHA will continue to face changes in its strategic direction and mandate which will impact operational and service performance. The relationships between strategy and governance documents, including gaps in documentation performance measurement is not linked to strategic outcomes. A performance agreement has not been documented between the Ministry and the Agency. SSHA’s current corporate balanced scorecard is not tied to its business plans (including financial and operational plans). To improve alignment, a new performance management initiative to develop a corporate balanced scorecard and associated divisional scorecards was launched in early 2006.

At the time of this report, this initiative is still in its early stages and its full impact will be difficult to assess until FY06/7 fiscal year end. In general, the Ministry, SSHA clients and other stakeholders are seeking more timely and consistent reporting, including qualitative and quantitative information on performance and the Agency’s contribution to overall health system performance.

Management decision-making processes have been inadequate to effectively steer the Agency. Strategic decisions regarding fundamental services, major scope changes or the addition of new projects are not well-documented. In the past, in-year changes in direction at short notice have created additional resource and funding pressure on SSHA.

In 2005, a new ‘funneling process’ was put in place to formally evaluate change requests or new project requests made by the Ministry or by SSHA. Each project is now required to go through feasibility and business case analysis before a go no-go decision can be made. All scope-change decisions must now be approved by the SSHA Board and the Ministry in writing. This is a very important, recent improvement in internal decision making, and reflects recognition on the part of the Agency that decision-making at the Ministry and the Agency has been ad hoc and uncoordinated, leaving stakeholders unclear as to the priority and rate of progress of various initiatives.

The recently implemented business and operational planning process (Q3 FY05/6), as well as the funnelling process are allowing SSHA executives and the Board to begin to make more informed decisions. These decisions must be ratified by the Board and submitted to the Ministry via the business plan document for approval. Variances from the business plan are reviewed on a monthly basis. Decisions regarding variances must also be approved by the Board and documented in the Board meeting minutes. Tactical decisions are made during regular weekly status meetings between project leads and the Executive Committee.

The Executive Change Management committee, supported by a director-level group facilitates the resolution of resource and scheduling conflicts between projects and divisions. Additional forums for decision making include a monthly, full-day SSHA Executive meeting for a comprehensive review of project and budget status; a quarterly, full-day SSHA Executive meeting to review the annual budget; and a monthly SSHA Board Meeting where key decisions are ratified.

With these mechanisms in place, the Agency will be better equipped to assess progress against approved plans and to stay focused on the achievement of formal commitments. In late 2005, formal meetings between SSHA management and the eHealth Office were instituted, which has resulted in more structured communications between SSHA and the Ministry.

The governance model has not encouraged the degree of partnering and collaboration required to deliver complex eHealth solutions. The principal governance relationship has been between the Ministry and SSHA management. The predominant focus is on budgeting, monitoring and control from a central planning perspective (e.g., eHealth Office).

At the same time, the Agency serves a number of clients within the Ministry (e.g., program owners) for whom solutions are being delivered by SSHA. These program owners often set the terms and conditions under which SSHA interfaces with the end-users of its services (e.g. health system providers). The result is that SSHA management is often faced with competing or contradictory demands from policy setters, program owners, funding managers, and users of its services. This reinforces a relationship between the Ministry and SSHA that is based on operational negotiation and control rather than collaboration.

It also leaves end-user customers unclear as to their role in priority setting. The Ministry, not having received the level of reporting it asked for from SSHA, has placed increasingly tight controls on the Agency, thereby inhibiting its operational independence. Administratively, the MOU between MOHLTC and SSHA is outdated and does not reflect the broader scope and accountabilities in the amended regulation. This leads to multiple interpretations of the mandate adding to confusion about SSHA’s role.

In 2005, the lack of a stable SSHA Board led to a governance gap that impacted decision-making over several months. As such, the FY06/7 multi-year business plan is not formally approved in writing by the newly instituted Board and Ministry. The introduction of a new Board for SSHA offers the opportunity to establish a more collaborative environment between the Agency and the Ministry. There is also a need to establish increased autonomy for the Agency to effectively build meaningful service relationships with the end-users of its eHealth solutions.

A clear accountability agreement with measurable targets and results does not exist between SSHA and the Ministry. Well-defined expectations, deliverables and measurable performance targets have not been established and documented by the Ministry for SSHA. For example, an annual accountability agreement with specific performance expectations has not been part of the governance model. This makes it difficult to assess the true performance of SSHA relative to expectations. As a result, the actual or perceived value of SSHA’s accomplishments against a $458 million investment over the last four years (including current year plan) is difficult to assess. Outcomes have also not been defined by the Ministry for the Agency, making it difficult for SSHA to understand the end-state of a project or initiative and work towards that state. The result has been a task-based approach to project delivery.

The Agency and the Ministry have different indicators and tools for measuring SSHA’s results. The new SSHA balanced scorecard has been strengthened over previous versions to include four categories – Client Perspective, Internal Perspective, Learning and Growth Perspective, and Stakeholder Perspective. Some basic metrics are in place. SSHA is in the process of researching other technical and financial metrics. Divisional scorecards are at the early stages of development in the eHealth Solutions Division and the CIO’s office. Many traditional metrics used for network and data centre management are not in place. The Ministry has also asked SSHA to report on four areas – Quality, Client Satisfaction, Pace of Delivery and Cost. The SSHA and Ministry performance measures and tools need to be aligned to a common set of agreed upon targets. A formal request for SSHA to present a performance scorecard to the Ontario e-Health Council in early 2005 has not been done to date.

The current legislation restricts SSHA from operating effectively as an arms length agency. SSHA operates like a division of government with its involvement in the RBP process, reliance on funding envelopes and working with holdbacks for in-year funds. Consequently, the Ministry (through the eHealth office) and central agencies are overseeing, reviewing and commenting on the financials and operations of SSHA at a detailed level.

By comparison, a transfer payment agency (such as Cancer Care Ontario or a major hospital) would operate with greater Board and management accountability for performance against approved strategies and plans. Such a structure could provide a number of benefits to SSHA including: the ability to carry-forward approved project funds into next fiscal year where legitimate issues had resulted in project delays; the potential to obtain revenue from clients for certain services where it has been proven economical to do so and performance targets are not compromised; and, the ability to enter into long-term, performance-based partnering relationships with industry or other stakeholders to leverage expertise and resources beyond those existing within SSHA.

Products and services lack clear, detailed definition. The lack of a detailed, standardized product and service catalogue leads to confusion about the scope and scale of SSHA’s offerings. Clients are unclear about the products and services provided by SSHA. In response, the Agency has started to develop detailed descriptions of the products and services it provides. Product descriptions for ONE Network and ONE Hosting are more clear and thorough than for ONE Mail, ONE ID, ONE Support and ONE Pages. The Agency has not yet progressed to a product and service catalogue with clearly stated service standards.

Client dissatisfaction with SSHA service levels is high. SLAs are not consistently defined or implemented with all clients. As a result, customized agreements are in place for most clients. Standardized client reporting against SLAs is minimal to non-existent. Management dashboard tracking of service level targets for incident resolution has only been in place for a few months (e.g. IS Enterprise Services Reports).

Service level performance is currently only managed for high-priority incidents. While some clients were appreciative of the efforts and service quality provided by individual SSHA employees, overall feedback from clients on service levels has been highly critical. Clients must deal with multiple SSHA or vendor contacts for service or technical issues. Clients find this confusing and are unsure of the escalation path for their complaints. SSHA has recently established a client service manager role to mitigate such issues.

Network and data centre costs can be more tightly managed. Network costs account for 22%of the FY06/7 operating budget. The budget for network operations has been increasing by 10% year over-year. The Agency is establishing a new network contract (currently in negotiations) that will become operational in 2007, with the objective of containing the growth of network costs. The two data centres constitute 20% of the FY06/7 budget, with facility rental expenses being the most significant contributor to data centre costs. The current proliferation of racks in the data centre may result in escalating facilities costs if the Agency does not take measures (e.g. server consolidation) to reduce the existing rate of floor space consumption.

SSHA created the eHealth Solutions Division (eHSD) to assist the broader healthcare community in developing and deploying applications. This division recently has taken on the responsibility of client service management. The division is comprised of dedicated project resources and resources that spend a portion of their time on operational and maintenance activities. SSHA is in the early stages of developing client reports but has not developed a definitive approach to such reporting. User groups or client councils have not been part of SSHA’s approach to managing client and stakeholder relationships.

Users’ expectations of SSHA often do not align with its actual mandate and capabilities. With one or two exceptions, external stakeholders were unable to provide a reasonably accurate list of SSHA’s products and services. Interviewees consistently stated their belief that the products and services they expect from SSHA are vital to delivering on their government-mandated responsibilities and objectives. These objectives include such things as: improved access to healthcare, progress against the provincial wait time strategy, improved health outcomes, and cost containment.

With the constant push by government to create greater integration across the Ontario healthcare system, stakeholders view SSHA as a key enabler for their specific technology needs. There is broad support for a provincial eHealth agency to promote integration and economies of scale. At the same time, stakeholders are frustrated by what they view to be slow progress with eHealth in Ontario. The lack of alignment between external stakeholders, the Ministry and SSHA has been exacerbated by performance issues and by SSHA’s limited engagement of stakeholders in processes that define Ministry and SSHA priorities and solutions.

As a result SSHA’s products and services are perceived to be ineffective. This has resulted in some client organizations moving ahead with their own technology solutions, security protocols and eMail systems. In time these standalone client projects may have serious implications for the overall eHealth environment and SSHA’s future role.

There is a perception that quality of products and services delivered by SSHA is poor. Stakeholders generally expressed dissatisfaction with the quality of SSHA’s products and services. They find varying degrees of quality and consistency in SSHA’s provision of basic infrastructure needs, network and connectivity services, as well as secure eMail. Numerous examples were provided relating to the lack of system availability, long turn-around times on requests for service, lack of bandwidth and lack of warnings or communications during system down-time. Other frustrations include:

• While SSHA employees are perceived to be technically proficient, they demonstrate little business acumen. This translates into an inability to understand client issues, manage client expectations and describe SSHA products and services in a meaningful way.

• SSHA is perceived as rigid and inflexible by many clients.

• The inability of SSHA to describe how SSHA measures and reports on its performance.

• Most users do not have Service Level Agreements, mainly because the process to agree on SLAs is too complex and long and where SLAs are in place, no feedback/reporting on it is done.

• SSHA’s communication and general engagement with stakeholders is insufficient for them to feel satisfied that the Agency values client relationships.

Stakeholders recognize that some of SSHA’s operational problems can be explained by the lack of maturity within the organization. They also realize that the lack of a clear mandate contributes to SSHA’s difficulties with operational planning and that SSHA’s execution of activities is shaped by the Government’s policies and priorities. However, on balance, our consultations with external stakeholders highlighted the widely held perceptions that SSHA:

• Offers products and services that are relatively ineffective;

• Delivers products and services inefficiently; and

• Does not measurably contribute to the efficiency of the healthcare system.

This has led to an erosion of confidence. Restoring credibility requires a concerted effort by the Agency.


Recommendations

To address the increased importance of the Agency in the future Ontario eHealth agenda, a number of recommendations for improvement and an associated implementation plan have been developed. Given the increased urgency for substantive progress with eHealth in Ontario, an aggressive, Agency-turnaround plan is required. As such, the high-level implementation plan included in this Report calls for the fundamentals to be implemented by March 31, 2007. Fiscal year 07/8 will also be required to fully implement the required improvements. The Ministry needs to own the eHealth program and be engaged at the level of making strategy, policy, and program decisions, and work with the Agency to implement appropriate solutions.

Reprinted from Canadian Healthcare Technology

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Story 5:

Three Ontario cities among 21 'smartest' global communities
By Kathleen Lau, IT World Canada

The Smart21 list, featuring the three Ontario cities (the only Canadian communities on the list) will be whittled down to just the top seven cities on Wednesday at a function to be held in sunny Honolulu, Hawaii.

From the Top Seven, in May, one exceptional community will claim the grand title of the year's Intelligent Community.

The ICF is a non-profit think tank that focuses on job creation and economic development in the broadband economy.

The ICF's initiatives to foster innovation in local communities worldwide include a 10-month "Intelligent Community" awards program. Communities around the globe can nominate themselves if they feel they meet the criteria for selection.

The ICF received about 400 nominations for 2007 that represented a good balance of regions around the world, according to a Forum spokesperson.

This year those communities have been evaluated based on their possession of six key capabilities: broadband infrastructure, knowledge workforce, digital inclusion, innovation and finance, marketing and leadership.

A committee consisting of ICF executive staff and academic researchers selects the 21 "smart" communities after assessing the legitimacy and completeness of the submissions.

Communities deemed admissible are scored using a numerical system devised by analysts and researchers. It's a second-time standing for all three communities, however, last year, Waterloo was the only one that made it to the Top Seven.

Six Canadian communities placed on the Smart21 list in 2006.

According to one ICF executive, the creation of a strong broadband infrastructure is crucial to a community's ability to survive and thrive.

"It's important for us to study the relationship between broadband infrastructure on economic growth and social development," says Louis Zacharilla, director of development at ICF.

Zacharilla believes such a relationship does exist, and understanding it is crucial to a region's transformation into an "intelligent community."

City of Waterloo councilor Mark Whaley echoes this view and says it's important for government, academia, business and non-profit organizations to be on the same page on issues that move the community forward. Besides collaboration, says Whaley, embracing new ideas and building upon them, and establishing roots is key to creating any innovative community that can hold its own in the world.

As an example of "openness to new ideas", he cited the University of Waterloo's initiative early in its 50-year history, to allow students and professors to own their research ideas and turn these ideas into money-making ventures.

This policy has contributed to the city's ability to stay ahead in the global rat race.

Whaley says former University students and staff turned entrepreneurs have, in turn, re-invested their entrepreneurial wealth in the city, resulting in "150 research institutes in Waterloo."

The idea that the fruits of investment will come full circle is echoed by a city of Burlington spokesperson.

"[Placing on the Smart21] gives us a [renewed] vision," says Randy Bennett, co-ordinator of network services for the City of Burlington. He said the honour will motivate the city to develop policies and programs designed that attract Fortune 500 companies, drive innovation and ultimately make Broadband accessible to everyone.

That investment will help Burlington economically by developing knowledge workers, Bennett adds.
That's a sentiment shared by Gatineau city officials as well.

Making broadband universally accessible within a community fosters effective communication, according to Mathieu Larocque, spokesperson for Marc Bureau, mayor of Gatineau.

"One of our goals was to be a transparent city where our citizens would have access to as much information as possible," he says.

According to Larocque, Gatineau was one of the first cities in Québec to broadcast council meetings live online, and the first in North America to web cast executive meetings.

Copyright © 2006 ITworldcanada.com

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Story 6:

Federal Government announces $2.6m project for pediatric wait times

TORONTO – Prime Minister Stephen Harper announced the federal government will invest $2.6 million in a Wait Time Guarantee pilot project for children in need of surgery.

“Ultimately, today’s initiative will lead to a Patient Wait Time Guarantee for all children,” said Harper.

The 15-month pilot project, scheduled to start this month (January 2007), will include the development of the first pan-Canadian information system to measure the burden of waiting times for children who need surgery.

It will also include the development of a clinical recourse plan for children whose surgical wait times fall beyond the clinical access guidelines that were proposed by the National Child and Youth Health Coalition and endorsed by the Paediatric Surgical Chiefs of Canada.

The initial focus of the project will be on six key surgical areas: cardiac, cancer, neurology, sight, spinal deformity, and dental treatment requiring anaesthesia. Within one year, one of these areas will be chosen to test a guarantee that will include recourse for patients who are waiting too long.

“As a parent, I know there’s nothing more heart-wrenching than seeing a child suffer,” said the Prime Minister. “Because they’re Canada’s future, our children deserve the best medical care possible delivered as promptly as possible.”

The project, which is the fourth such wait-time guarantee initiative announced to date by Canada’s New Government, will be conducted in partnership with Canada’s 16 paediatric academic health science centres under the leadership of the Paediatric Surgical Chiefs of Canada and The Hospital for Sick Children.

The announcement generated criticism from some provincial and federal observers.

Ontario Intergovernmental Affairs Minister Marie Bountrogianni said Harper should be “ashamed” for neglecting to consult the provinces before unveiling the pilot project.

Harper made the announcement at the Hospital for Sick Children in Toronto – a few blocks away from the Ontario legislature – and was joined at the news conference by Health Minister Tony Clement, a former Ontario cabinet minister.

“Many children do not receive the care they need in a timely manner,” Harper said. “Too often, they hear the words that haunt the entire Canadian healthcare system: ‘Sorry, you’ll just have to wait.”’

Wait times, however, are a provincial responsibility, said Bountrogianni, who was angry that the federal Conservatives failed to notify the provinces about a project she dismissed as being far too small to have much impact on wait times in Canada.

“We weren’t invited to the announcement, and I can almost understand why: it’s such an insignificant amount of money,” Bountrogianni said. “This is not the way to do intergovernmental relations in this country.” The Ontario government has spent $611 million over the last two years on its own plan to reduce wait times, which is expected to play a prominent role in this fall’s provincial election campaign.

Hiring more nurses and doctors would be a much more effective way of reducing wait times, said NDP child care critic Olivia Chow.

“Children cannot wait if they need surgery – having a pilot project and then deciding what to do is really redundant,” Chow said. “We need healthcare workers today to shorten the wait times for children, not in five years’ time.” Harper acknowledged the pilot project by itself wouldn’t solve the thorny problem of wait times in Canadian hospitals.

“We’re not going to snap our fingers and say today’s the day that wait times are solved,” he said. “It’s obviously going to take some time.” The provinces manage the existing program for reducing waiting times in five key areas, including joint replacements, heart and cataract operations and diagnostic imaging.

Harper rejected suggestions he and Clement devised their announcement to avoid having anything to do with Ontario’s Liberal government in setting up the project.

“The project in question was actually put together by the 16 pediatric hospitals themselves . . . what the federal government is announcing is their support for that initiative,” he said.

“If the province of Ontario also wanted to participate, I’m sure they would welcome that participation.”

The federal Conservatives have already announced similar wait-time initiatives focused on diabetes and prenatal care for First Nations patients.

© Canadian Healthcare Technology 2007

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Story 7:

Edmonton plans $60 million orthopedic surgery centre

“It will be the first of its kind in Canada,” Joanna Pawlyshyn, vice-president and chief operating officer at the hospital, told the Edmonton Journal. “It should allow us, in the end, to provide the best access to joint surgery in Canada right here.”

Construction on the new 80,000-square-foot facility, with two operating rooms and 150 staff, is scheduled to start this spring; it is to be completed in early 2009. The goal is to have hip and knee patients up on their feet and back home four days after surgery.

The rooms are significantly larger than older ones, providing enough space for physiotherapists to work directly at a person’s bedside instead of having patients wheeled to a rehabilitation space.

Capital Health is already rolling out a new system that aims to have 90 percent of joint-replacement operations done within 20 weeks of the initial consultation, down from a previous 82 weeks.

About 50 percent of the 3,000 annual joint operations in the region are done that quickly now.

The 90 percent target should be reached within a year, even before the new building is complete, since operating rooms and beds at the Royal Alexandra, Misericordia and University of Alberta hospitals have been devoted to the program. The new facility will help surgeons maintain that target and see the number of joint surgeries increased to 3,600 a year.

“It will allow us to become super-efficient, to improve the length of stay so we can move patients through more quickly and have them receive better care and be able to move into active lives more quickly,” Pawlyshyn said.” It will provide certainty to the public when they have their procedure booked that it’s not going to be bumped because we’ve got emergencies.”

Currently, about five to six joint surgeries have to be cancelled each month because of pressures in the hospital, said Dr. Don Dick, the medical lead of bone and joint health in Edmonton. Every hospital needs more space and more beds to keep up with the growing population.

The orthopedic surgery centre is part of a number of ongoing projects at the Royal Alexandra hospital that includes 14 new laboratories in the newly constructed Lois Hole Hospital, which will focus on women’s and children’s health issues, as well as a new $3.5-million in vitro fertilization clinic, scheduled to open this spring.

The new orthopedic surgery centre will move at least some of the hip and knee operations out of the main hospitals, freeing up room there to complete other services, Dr. Dick said.

In the next year, the administration will have to decide if all joint-replacement surgeries will be done out of the new facility or if some will remain at other hospitals.

In the last year, Capital Health saw a 10-per-cent jump in the number of people needing joint replacements and expects that rate of increase to continue for the next few years, especially with the aging population. Other orthopedic day surgeries, such as ligament reconstruction and arthroscopy of the knee, will also be performed in the new building to maximize its use. The full load of knee and hip replacements will be phased in over time.

Reprinted from Canadian Healthcare Technology

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Story 8:

Calgary Scientific’s 3D medical imaging system integrated into EMR

LINCOLN, Nebraska and CALGARY, Alberta – MacPractice, Inc., a developer and supplier of client-centric practice management software solutions, and Calgary Scientific Inc., a developer of advanced 3D medical image visualization software solutions, have announced the signing of a product integration and distribution agreement for the ResolutionMD product family developed by Calgary Scientific.

Designed for use by primary and specialty care physicians, chiropractors, dentists, and optometrists, MacPractice software incorporates ResolutionMD software as an optional module for viewing CT,MR and ultrasound scans, making it a more powerful solution for radiologists, cardiologists, neurologists, orthopedists, medical imaging facilities and other specialty practices.

The integrated product line combines best-of-breed technologies into the industry’s first medical practice management software solution that is equipped with FDA-approved medical imaging visualization and analysis software for use on the MacOS X platform. This solution is available at a fraction of the cost of traditional systems, according to the companies.

Mark Hollis, President of MacPractice, Inc., said: “Bringing powerful, easy-to-learn and use tools to the desktops and laptops of doctors’ practices, at a fraction of the cost of traditional systems, enables medical practices of all sizes to benefit from the latest advances in practice management and medical-imaging technologies.”

“With access to medical scans – in both 2D and full color 3D views – right on the same desktop managing patient-record information, doctors are able to assess and communicate injuries and disease faster and more clearly, accelerating and improving the quality of patient care,” said Byron Osing, CEO of Calgary Scientific.

About MacPractice
MacPractice, Inc. is a client-centric practice management software development firm who are dedicated to the development and support of best-of-class Macintosh software, hardware, and associated services for physicians, dentists and chiropractors.

About Calgary Scientific
Calgary Scientific Inc. is a software and intellectual property development company specializing in sophisticated digital signal, image processing and analysis technology. Through its Medical Group business unit, the company offers software designed to maximize the value of medical imaging data and to make it more accessible, thereby improving quality of care while reducing costs associated with image-based medical diagnoses and procedures. The company currently has 13 patents approved or pending approval. Find Calgary Scientific Medical group at www.calscimed.com.

© Canadian Healthcare Technology 2007

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Story 9:

Inflazyme Pharmaceuticals Announces Corporate Restructuring

VANCOUVER, British Columbia, Feb. 9, 2007– Inflazyme Pharmaceuticals Ltd. (TSX: IZP) today announced that it has undertaken a corporate restructuring, following its announcement on the results of the Phase 2b CAPSICS study on January 29, 2007. The results demonstrated a surprisingly large placebo response in the asthma trial which obscured any potential effects of the drug.

The restructuring, which takes effect immediately, will reduce the Company's expenditures and improve its cash position. This will allow the Company time to select the best strategic option to maximize value for shareholders. The restructuring involves a reduction of approximately 70% of the Company's staff. The costs associated with the restructuring are estimated to be C$600,000.
We expect that following the implementation of the restructuring and finalization of the costs associated with the CAPSICS study, the Company will have reduced its burn to approximately C$400,000 per month with sufficient cash to take the Company into the second half of 2007.
Apart from the asthma product, Inflazyme has other LSAIDs for respiratory and inflammatory disorders, a PDE4 inhibitor product partnered with Helicon Therapeutics under a limited license agreement, and other PDE4 inhibitors at pre-clinical stage.

“We are very disappointed to be letting go our employees, most of whom have been with Inflazyme for several years and all of whom have made significant contributions to our Company, our technology and programs. We greatly appreciate our staff for their dedication, commitment and hard work. This is a necessary action in light of the disappointing results from the Phase 2b asthma trial, our lead program,” said Dr. Kevin Mullane, President and CEO of Inflazyme Pharmaceuticals.

The Company is still on track to report the outcome of the validation process that was instituted to investigate the results of the Phase 2b study. As previously announced, the Company expects to report on the results of the Phase 2a study with IPL455,903 in Age Associated Memory Impairment this quarter.

Contact:
Inflazyme Pharmaceuticals Ltd.
Julie Rezler, Sr. Director, Corporate Development
Tel:  1.800.315.3660/604.279.8511
Fax:  604.279.8711
E-mail:  ir@inflazyme.com 
Web: www.Inflazyme.com

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Story 10:

Hospitals unprepared for pandemic surge
By Dan Childs
ABC News Medical Unit

Feb. 5, 2007 - At the recent gathering of many of the world's top influenza experts in Washington D.C., projections outlining how hospitals would deal with a pandemic event were easy to find.
Optimists, however, were in shorter supply.

"We need double the floor space, double the physical space," said one presenter at a poster session of the Seasonal and Pandemic Influenza conference. "It's just not gonna happen."
Another expert nearby presented her poster on possible triage strategies.

"We'll need a more effective triage system to determine who gets the care and who's too far along," she said.

Computerized training simulators. Strategies to discharge patients quickly and use hallways for bed space. All are approaches are designed to deal with what those in attendance at the meeting called a "surge" - the increase in people needing hospitalization in the wake of a flu pandemic.
But if an influenza pandemic were to begin tomorrow, the country's hospital beds would soon be filled to capacity.

It is a projection that would surprise few public health experts. But data presented at the meeting paints a sobering picture of how profound and overwhelming the surge could be.
"It is the big unaddressed issue, and we're only beginning to talk about how to provide care to people," said Jeffrey Levi, executive director of the Trust for America's Health. "We need to be talking about this."

"Of all the things that keep you awake at night, this is the one that does the most," said Dr. Allen Craig, director of communicable and environmental disease services at the Tennessee Department of Health.

"We don't have this capacity now, and frankly it's going to be very hard for us to come up with it in a pandemic situation."

Surge Would Strain Facilities, Staff

Dr. Eric Toner, senior associate at the Center for Biosecurity at the University of Pittsburgh Medical Center, conducted a study last year to determine the capacity of the nation's hospitals to accommodate a pandemic surge.

"In a moderate scenario, an additional 19 percent of non-ICU beds, 46 percent of ICU beds and 20 percent of ventilators would be in use by flu patients," Toner said. "This is pretty much all of the surge capacity we have in most hospitals, so if we're lucky and it's a mild pandemic, we will be stretched to our limit."

But these limits would quickly snap in the face of a major pandemic. "If we have something like the 1918 pandemic, we're in big trouble," he said. In this situation, a hospital would need to double the number of non-ICU beds just to deal with the flu patients - and that is if every other patient was discharged. The need for beds in intensive care units would quadruple, and twice the number of mechanical ventilators would be needed.

For many hospitals, this type of increase in demand would force difficult decisions. Bartlett said that his medical center currently runs at about 95 percent occupancy.
"If we had to double the number of beds, many of the patients that are there now would have to be relocated," he said.

Dr. Richard Lee, professor of medicine at the State University of New York at Buffalo, said of one of the hospitals he works with, "We have 200 to 300 beds there, so we'll run out of beds pretty quick."

The situation at individual hospitals calls for an adjustment of the role of these facilities when it comes to this type of emergency.

"Clearly when planning for this, we are no longer talking about surge capacity," Toner said. "Rather, I believe we are talking about surge strategies or capabilities."

More often than not, these strategies would involve keeping many patients out of hospitals altogether - not only to make the most of scarce resources, but also to keep additional patients from getting sick.

"Hospitals are not designed necessarily to reduce contagiousness," said Dr. John Bartlett, chief of the division of infectious diseases at Johns Hopkins University School of Medicine. "And in SARS and other epidemics they are infectious disease amplifiers."

A Pandemic Scenario: New York City

Dr. Michael Tapper is an epidemiologist and director of the division of infectious diseases at New York City's Lenox Hill Hospital, which has 650 to 700 beds. Tapper says that the capacity of his hospital would be quickly outstripped in the event of a pandemic infection.

But the bigger problem, he says, is that the same thing would be happening all around the city. And densely populated areas like New York could bear the brunt of the patient surge problem.

"New York City has done a survey and surge capacity, and in the city, our surge capacity is very low because most of our beds are fully occupied most of the time," Tapper said.

He added that the shortage of hospital space would not be the only problem. Rather, finding the staff necessary to treat patients would present a special challenge. He said this includes nurses, who are already in short supply, and respiratory therapists.

Bartlett said conditions created by the flu itself could further intensify the strain on the available workforce. "Thirty percent of the health care workers in a given hospital will be out with the flu," he said. "Others will have kids to take care of because of school closures."

In order to take the strain off of medical facilities, non-traditional clinics could be set up in schools, civic centers and other public buildings. But in all likelihood, these temporary facilities would not provide medical care - only food, water and a place for New York's displaced patients to sleep.

Preparing for a 'Diminished Standard of Care'

In the surge scenario described above, it is easy to see how those seeking medical care would likely have to accept what infectious disease experts call a "diminished standard of care."

This would involve triage and rationing of service and supplies in order to milk the full potential of every resource. And it could mean that the role of hospitals could be shifted away from saving every patient, and toward leveraging resources to save those patients who can still be saved.

Bartlett said this could be a difficult notion for the public at large to swallow. But he added that absent a major preparation effort, such a situation may present itself if a major pandemic strikes.
"Nobody can deal with the surge thing," he said. "It's beyond reach, I think."

©ABC News

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Story 11:

Health-care orgs explore scheduling app for pandemic preparation SARS provided lessons on communications issues, OHA attendees told
By Sarah Lysecki

TORONTO – The health-care system would not be ready for another SARS-like outbreak if one hit as soon as tomorrow, according to a Sudbury doctor who has invented a scheduling and communications tool for health care workers.

“We would have the same confusion as SARS if a pandemic occurred tomorrow,” said Dr. Dennis Reich, president and medical director of Sudbury and District Medical Society. “In a pandemic situation, not everyone would run to their Tablet PC.”

Reich, who founded Chyma Systems Inc., added the health-care community needs to divert its attention to improving communication when planning for a pandemic.

Health-care systems worldwide are bracing themselves for the possibility of a global disease outbreak or pandemic of a new influenza virus such as the H5N1 or “avian bird flu” for which people have very little or no immunity and for which there is no vaccine.

Reich was one of three presenters at a recent session at the Ontario Hospital Association's HealthAchieve2006 convention here. The session looked at how physician scheduling software like Chyma could be used as a pandemic communication tool.

Chyma (www.chyma.net), which is owned by its parent company ISAIX (www.isaix.com), stemmed from a Web site that Reich created in 1999 and was launched as a software product several years ago. The online tool replaces paper-based scheduling systems with one that gives doctors a single access point to physician scheduling and shift trades, calendars and events, documents, contacts, messaging and discussions. There are currently 12,000 users located across Canada. The scheduling module, called OnTime!, costs $5.95 per user per month while the communications component is based on a volume pricing model.

While this type of tool is not a means to an end, it would help to eradicate some of the confusion, especially at the family physician level, that surrounded the SARS outbreak in 2003. Janet Kasperski, executive director and CEO of The Ontario College of Family Physicians, said during the SARS break family doctors had to deal with the majority of people affected by the disease but were given the least information.

 “We were treated like mushrooms,” said Kasperski. “We were kept in the dark and fed with sh--t.”

Eighty per cent of people access the health-care system in Ontario through their family doctor and not the hospital. Yet much of the media attention and information coming down from the Ministry of Health Care focused on the hospitals and other tertiary care facilities.

“During SARS, family doctors weren't informed by authorities,” said Kasperski, adding that at Scarborough Hospital, where the first outbreak occurred, many family doctors didn't even have the privileges to access the information. “We struggled alone.”

The mass chaos that surrounded the SARS outbreak was the catalyst for Scarborough Hospital to implement Chyma a couple of years ago. Dr. Christopher Jyu, who works at the hospital and was at the front lines during SARS, said at that time, only 50 per cent of the hospital's staff used e-mail as a means to communicate with each other. This made it difficult to communicate changes to staff that were happening on a daily basis, such as which entrances were open and which were closed.

Now, with the tool in place human resource planning is, “easy for us to regroup doctors in case of change of location,” said Jyu. Some of the other key benefits include the ease of swapping shifts, up-to-date contact information and the ability to access the software from anywhere in the world, Jyu added.

Reich, who sits on a pandemic planning panel, said while he supports top-down approaches to improving the flow of information in the health-care system such as Canada Health Infoway's billion-dollar initiative to eradicate paper from the system by the end of the decade, grassroots initiatives like Chyma help to break down the silos created by a smattering of proprietary-based electronic medical record systems.

“The other way is to have systems that are technology agnostic without the concern that the privacy of records is compromised,” he said.

Reprinted with permission. © 2006. Transcontinental Media Inc. All rights reserved.

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Story 12:

Billion dollar pills: An overhaul at Pfizer, the biggest and most conservative of drugs firms, shows what ails the industry
NEW YORK, Jan 25th 2007
From The Economist print edition

 “DEATH is optional,” says a smiling David Brennan. As an American, he is only half joking about his homeland's demands for a cure for everything. But as chief executive of AstraZeneca, a big British drugs firm, his brimming self-confidence is a reminder of the genuine long-term promise of the pharmaceuticals industry. The world will always need health care—and more and more of it as developed countries grow older and developing nations grow richer. The demand for new drugs can only increase.

Yet the clouds have darkened over Big Pharma. The industry's share prices have performed pitifully and a new report from Accenture, a consultancy, calculates that a whopping $1 trillion of “enterprise value”, which measures future profitability, has been wiped out because investors have lost faith in drugmakers' growth prospects (see charts).

Three of the biggest drugs firms have brought in new bosses to help turn things around. One of them is Jeffrey Kindler, the chairman of Pfizer. This week he unveiled a strategic overhaul of a magnitude rarely seen in this business. The world's biggest drugs firm is cutting 10,000 jobs, about a tenth of its global workforce. About a fifth of its sales force in Europe and America will lose their jobs and up to five research centres and several manufacturing sites will close. “There are no longer any sacred cows,” promised Mr Kindler.

Usually a company's share price rises when it reveals a plan to cut costs. Pfizer's fell slightly. Why? Because Pfizer, once the leading light of the drugs industry, is in serious trouble. Net profits dropped during the fourth quarter of 2006 by 12%, to around $3 billion, compared with the same period a year earlier (after stripping out the sale of Pfizer's consumer-products division to Johnson & Johnson). Its annual sales of some $48 billion are stagnant and may well shrink.

The chief reason is that Lipitor, the anti-cholesterol drug that accounts for nearly $13 billion of Pfizer's revenues and over 40% of its profits, is losing steam. Sales are missing the company's own targets, even before its patent runs out in about four years. Those sales will then collapse as copycat products are churned out by the producers of generic drugs.

Pfizer had bet heavily that Torcetrapib, a novel cholesterol remedy it was developing, would be the blockbuster to replace Lipitor and help save the company. But in December concerns over safety caused the new drug to be unexpectedly dropped. With it went Pfizer's single best shot at avoiding a financial disaster.

The Winds of Change
Now Mr Kindler has to try other ways to revive Pfizer. That means tackling the three big trends confronting the industry. First, profits are getting squeezed as generics firms grow bolder and the big purchasers of drugs try to save money. Second, it is getting harder and costing more to find new treatments. And lastly, the industry is trapped in a marketing and sales arms-race that has diverted resources from research and provoked a public backlash.

This mixture of difficulties explains why the cost of bringing new drugs to market has soared dramatically. Experts differ on how high: estimates range from $500m to $2 billion. Regina Herzlinger, of Harvard Business School, has scrutinised the sums and is certain the era of the billion-dollar new drug has arrived.

The risks have been compounded by vertical integration, reckons Roger Longman of Windhover Information, an industry consultancy. Unlike firms in other businesses, Big Pharma still does most things in-house, from research to manufacturing, sales and distribution. Mr Longman insists that big drugs firms must move towards a “disaggregated” model to focus on a few core areas of competence, such as drug discovery, development or marketing. Many activities can be put out to the growing legion of biotechnology start-up firms, contract research organisations, independent drug-development firms and freelance sales organisations.

The vertically integrated business model was hugely successful for decades and helped to boost the quality of drugs. It still has its defenders. Daniel Vasella, chairman of Novartis, a Swiss drugs giant, insists that talk of a crisis is overblown: “Individual firms may rise and fall, but I believe the innovative power of the sector remains strong.” Stuart Harris, an analyst at HSBC, argues that the difficulties are cyclical and the basic business model is not broken. Others observe that the business has historically enjoyed profit margins of some 20%, double those typically earned by Big Oil.

But look beyond past glories and theoretical future drugs to see the dangers. The petroleum analogy points to the root cause of the problem: uniquely among big industries, notes Joseph Fuller, head of Monitor, a management consultancy, the oil and drugs businesses are “self-liquidating”. Hence Coca-Cola can peddle the same sugary syrup for decades, but an oil company has to keep discovering new fields and a pharmaceuticals company must keep refilling its drugs pipeline.

For a drugs firm renewal is even more pressing, given the abrupt nature of patents' expiration. When patents on blockbusters like Lipitor run out, generic competition ensures that prices collapse quickly—sometimes to a tenth of their former levels. Unless drugs firms continually bring enough new products to market to replace lost revenues they will shrivel and die. “Yes, this is a 'cyclical' downturn,” says AstraZeneca's Mr Brennan. “But a lot of the top 20 drugs firms [of a few years ago] aren't around any more because they couldn't get out of the last cyclical downturn by coming up with key new drugs.”

The drugs industry has always faced this problem, but once it could count on earning fat margins on not just new drugs but also “me too” treatments that were only marginally better than existing therapies. Then governments in Europe, Japan and Canada began demanding big discounts. For a while the industry has found comfort in free-market America, where most big drugs firms earn half or more of their profits. But America's willingness to pay over the odds for new treatments could be coming to an end.

The newly Democratic Congress is talking about cutting drug costs through direct government negotiation with firms. Pfizer's Mr Kindler is convinced America will not embrace price controls, but even so acknowledges that his industry faces pricing constraints. America's private insurance firms and “pharmacy benefit managers”, including those running the government's Medicare drugs scheme, are also looking for savings. So are big employers like General Motors and Wal-Mart.

The march of generics
The global generic-drugs market is worth nearly $60 billion and well over half its pills and potions are sold in America and Britain, reckons IMS Health, another consultancy. By 2009 a dozen of today's top 35 branded prescription drugs will lose their patent protection. Viren Mehta, an industry expert, estimates the global drugs industry's annual sales to be about $300 billion and that some 30% of it will be attacked by generics in America alone over the next five years.
No wonder generics firms are growing in confidence. Last year, Apotex, an obscure Canadian generics firm, outmanoeuvred Bristol-Myers Squibb and managed to launch a generic version of Plavix, a blood-thinning drug. The resulting financial chaos led to the ousting of Bristol-Myers's boss. The firm is now considered to be a likely takeover target.

Ranbaxy, a big Indian generics firm, gobbled up six competitors last year and is now talking with private-equity firms about a bid for the generics arm of Germany's Merck. Ranbaxy's boss, Malvinder Singh, scoffs that Big Pharma “is struggling to come up with true innovation”. He sees his firm becoming one of the world's top producers of generic drugs within five years. Mr Mehta believes that by 2010 Indian drugs firms could account for six to eight of the world's top 50 drug companies by market share.

The tables are turning, but Big Pharma has not given up the fight. Its armies of lawyers aggressively defend patents, even flimsy ones taken out on minor tweaks to existing treatments. American firms, including Pfizer and Merck, are trying to launch their own “authorised generics” a few months before patents expire to try to blunt the impact of competition. But the effort is largely in vain.

The future of pharmaceutical research may be unfolding in an unfashionable neighbourhood in West London. In a gleaming new building next to Hammersmith Hospital, GSK, a British drugs giant, is working with experts from Imperial College and the hospital on a radical new approach to finding drugs. Using molecular imaging techniques, scientists are studying how humans respond to “micro-doses” of innovative drugs in real time.

Paul Matthews, an Oxford professor and head of GSK's imaging centre, thinks this will lead to a new “iterative, segmented approach to drug discovery” that contrasts with the broad-brush search for “one size fits all” blockbusters. For example, using genetic screening and clinical imaging, his team is trying to work out why the neighbourhood's many South Asians tend to have more heart attacks than its white population—and whether new drugs could be developed to target niche markets more effectively.

With its traditional approach, Big Pharma is not coming up with new drugs fast enough to fill its emptying pipeline. According to CMR International, a consultancy, in most years in the 1990s the industry spent roughly $35 billion-40 billion on research and development and produced 35-40 new drugs. By 2004 spending had swept past $50 billion, but the number of new drugs had fallen below 30. Now annual spending exceeds $60 billion, but the number of new drugs has still to grow.

Mr Harris, the contrarian HSBC analyst, maintains that the situation is not so bad if one measures output in terms of the total profitability of new drugs. Fair enough, but that presumes that the industry can keep coming up with blockbusters. And there is good reason to think that the era of blockbuster drugs is over. As Henri Termeer, chief executive of Genzyme, a big biotechnology firm, argues, “the blockbuster model becomes less important over time as specialised therapies take off.”

So-called “personalised medicine” has long been the Holy Grail of drugs researchers. This points to one explanation for how Big Pharma's research laboratories got into trouble: the shift from conventional chemistry to the “new science” of biotechnology. Most of the dramatic scientific advances in genetics, proteomics and pharmaco-genomics have come not from the industry's cosseted and costly research centres but from academic labs and biotechnology start-ups.

In one sense, the research crunch is not entirely Big Pharma's fault. Patricia Danzon, of the University of Pennsylvania's Wharton Business School, argues that the industry is a victim of its past success, having grown fat on making drugs for easier to tackle illnesses. Monitor's Mr Fuller believes drug labs “are not very different today from what they were in the 1970s”: ie, big, centralised and bureaucratic. Indeed, bosses may have hurt the discovery process with an orgy of dealmaking that has turned Big Pharma into Enormous Pharma. Mr Longman, of Windhover, insists that consolidation “did absolutely nothing”, other than taking out some costs and adding more bureaucracy.

Mr Termeer, Genzyme's boss, goes further and decries the “not invented here” culture at a typical drugs lab. His firm is a start-up. “Dealmaking and alliances came naturally as we had no resources.” Dr Vasella, Novartis's boss, stoutly defends recent mergers, but accepts that big firms must now look outside for inspiration because “we can't do it all ourselves.”

Desperately seeking drug hunters
The drugs-company bosses are pushing scientists out of their ivory towers. Rather than maintain so-called “centres of excellence” scattered around the world, Pfizer will consolidate operations along a few therapeutic lines (such as cancer, diabetes and so on). Mr Kindler also wants his secretive researchers to open up and work more closely with outsiders. He has put the company's drugs pipeline on the internet for all to scrutinise and declared his intention to pursue outside collaborations and acquisitions keenly.

To this end, Pfizer is following GSK's lead. A few years ago, the British firm broke its research operations into smaller therapeutic groups, with managers given budgetary and decision-making authority. Encouraged by early results and outside praise, the firm is now going further: setting up small units allowed to collaborate with biotech firms—even if the drugs involved compete with those being developed in-house.

Harder still will be breaking the addiction to blockbusters. Bill Ericson, of Mohr Davidow, a Californian venture-capital firm, believes that Big Pharma is so big it simply ignores business opportunities worth less than $1 billion. “We need to be as effective at selling a large number of $500m drugs as we are at selling drugs with multi-billion-dollar sales,” acknowledges Mr Kindler. To the industry's credit, it has come up with some early successes in personalised medicine: Novartis has a new specialised cancer drug that has won praise; a Pfizer drug, Maravirok, is aimed at only a specific type of AIDS sufferer.

Such personalised medicine means huge sales forces are no longer necessary, says Harvard's Ms Herzinger. But can Big Pharma really change how it markets drugs? “If the drugs industry is so proud of being innovation-driven, why is it spending twice as much on overhead and marketing as on research and development?” asks Mr Mehta. Activists have long criticised the industry's defence of patents and unrestricted pricing, decrying huge marketing budgets as wasteful (and, they allege, intended to corrupt doctors). Doctors and patients alike have grown increasingly sceptical. America's Congress is about to hold hearings on whether there should be curbs placed on the industry's advertising.

In America, where firms have been allowed to peddle pills on television, consumer drug advertising has shot up from $1.1 billion in 1997 to perhaps $4.5 billion last year. The reason firms headed down this path is that it seemed to work. AstraZeneca's boss, Mr Brennan, is a former drugs salesman and he acknowledges that companies may have gone too far. Visits by numerous different salesmen to the same doctor have escalated into a costly practice. Pfizer now plans to restrict such visits. GSK's boss, Jean-Pierre Garnier, has vowed to cut marketing expenditure and use the money for drug discovery.

But drugs companies will have to do more than tweak their sales methods. Eric Park, of Ziba, a design consultancy, reckons companies must also think about drug delivery systems and patient-friendly packaging, which could create a new kind of branded intellectual property that might be more defensible than drug patents. For instance, Advair, an asthma product from GSK, comes in an innovative, multi-dose inhaler that is breath-activated and easier to use.

The idea of marketing men having more sway over the men in white coats angers some traditionalists. Novartis's Dr Vasella calls the notion “stupid”. But it is applauded by Johnson & Johnson, the only drugs firm that has for decades been nimble, decentralised and consistently more innovative than its rivals. Paul Stoffels, its head of research, insists that “value for the patient” is the key to recovering the cost of new drugs.

Uli Hacksell, the head of America's Acadia Pharmaceuticals, agrees. He says the future belongs not to those who develop science for the sake of it, but market-minded “drug hunters” who pick and develop drugs that patients want and need.

So, will Pfizer's new strategy work? Mr Kindler says the object of his reforms is to inject “a sense of urgency” into his firm's researchers. Drugs are an inherently risky business, but he wants to reduce the risk of failing late in the game (as with Torcetrapib) by conducting lots of experiments and either abandoning unlikely candidates or scaling up quickly—a practice that General Electric cultivates as “fast failing”.

Having come from outside the drugs industry may help. Mr Kindler joined Pfizer in 2002 as general counsel after holding a senior legal post at McDonald's. He deserves credit for grasping the industry's problems quickly and then trying to tackle them. His reforms are well thought out and offer clear benchmarks for outsiders to measure progress. Analysts at Goldman Sachs, an investment bank, have praised the new strategy for showing “a path through Pfizer's black hole”.

But the biggest obstacle will be the industry's corporate culture. “You can't transform overnight into a decentralised organisation,” Johnson & Johnson's Dr Stoffels observes. Mr Kindler acknowledges this, but says his experiences outside the firm showed that people like working without layers of bureaucracy. He hopes to win converts as Pfizer finds success, but is under no illusion about the difficulty of the task. As he put it this week: “We're changing the tyres on a moving vehicle.” It is a feat few others would attempt.

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Story 13:

Doctors and Drug Makers: A Move to End Cozy Ties
By STEPHANIE SAUL,
The New York TImes

More Hippocrates, less Hunan hot sauce. Free lunches for doctors are under attack yet again.
Free lunch deliveries to medical offices, along with those ubiquitous drug company logo pens, have come to symbolize the extensive financial ties between doctors and the drug industry. And there is evidence they influence which drugs are prescribed.

But pressure is building against the widely reported gifts and other potential conflicts, an effort that took hold last year when a group of influential doctors condemned financial arrangements between doctors and drug companies in The Journal of the American Medical Association.

Tomorrow, a new push is scheduled to be announced by Community Catalyst, a health care consumer advocacy group based in Boston, and the Institute on Medicine as a Profession, a research group at Columbia University.

With a $6 million grant from the Pew Charitable Trusts, the organizations plan a national campaign calling for restrictions on the interactions between doctors and drug companies, and urging doctors to base their prescription writing more on medical evidence than on marketing.

“If you’ve been in the waiting room when these Chinese lunches are taken into the back office, it may raise the question whether the decisions are based on the best scientific evidence about medication or whether or not those Sichuan shrimp have something to do with the prescribing patterns,” said Jim O’Hara, the managing director of policy initiatives at Pew.

The pharmaceutical industry spends $12 billion a year marketing to doctors, and much of that money is in the form of free samples delivered to doctors’ offices, often accompanied by lunch for the entire staff. When the University of Michigan health systems banned such lunches in 2005, they calculated that the lunches had been worth $2.5 million a year.

The free drugs are samples of the newest and most expensive branded products. The drug industry hopes that by starting patients with free samples, they will remain on the more expensive medication rather than using a cheaper generic. And there is evidence that doctors who have relationships with the pharmaceutical industry prescribe more of the expensive drugs.

The new initiative, called the Prescription Project, is an outgrowth of an article published in January 2006 in The Journal of the American Medical Association in which a coalition of scholars and doctors proposed that academic medical centers across the country take the lead in restricting interactions between doctors and the health care industry.

Several medical centers, including those at Yale, the University of Pennsylvania and Stanford, have announced such restrictions.

The Prescription Project aims to spread those restrictions to other academic medical centers, doctors’ organizations and third-party payers.

Some medical school deans are reluctant to impose such restrictions, fearing that they will lose research money, according to David J. Rothman, an author of last year’s journal paper who is also president of the Institute on Medicine as a Profession.

“They say, ‘If we did this, we would lose a third of our faculty. They’ll go to places with less stringent requirements; if we did this, we’ll tick off the drug companies and there’ll be payback,’ ” said Professor Rothman.

One of the group’s plans is to document the impact of changes at Yale, the University of Pennsylvania and Stanford. “Did the drug companies stop giving Penn research money?” he said. “I don’t for a minute believe that is going to happen.”

The organization’s goal is not to prohibit research grants or consultancies, but to limit gifts, travel fees, speakers’ bureaus and ghostwriting while at the same time encouraging prescriptions based on a medical evidence.

“Gifts bring with them the felt need to reciprocate,” said Professor Rothman, who teaches social medicine at Columbia.

“We’re not saying you’re being bribed,” he added. “We’re saying you’re being gifted. Some of it could be raw monetary hustling. But some of it is this psychological — ‘Well, they just sent me out to Las Vegas, their drug is as good as anybody else’s, why not just say thank you.’ ”

©The New York Times

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Story 14:

Provinces unite on cancer drug evaluations
Canadian Press

TORONTO — All provinces except Quebec have agreed they will collaborate to review new cancer drugs instead of conducting independent evaluations.

The Joint Oncology Drug Review, announced Thursday, will reduce duplication and help ensure faster, more effective evaluation of cancer drugs, said a statement from the provinces.
The interim initiative will remain in place for one year before participating governments decide whether to formally implement a national program.

“There's been a lot of criticism about checkerboard coverage in Canada for new cancer drugs,” said Terry Sullivan, president and CEO of Cancer Care Ontario.

“This is an attempt to say let's put all the information on the table, let's bring the best people. let's bring the highest standards of evidence. And let's bring transparency to the process, including patient participation.”

Cancer Care Ontario is an umbrella organization that steers and co-ordinates Ontario's cancer services and prevention efforts. Beginning March 1, manufacturers of new cancer medications will make one submission asking provinces to cover the cost of the drugs.

The submission, to an Ontario evaluation committee, would be considered a request to all the participating provinces and territories. Final coverage decisions, however, will remain the responsibility of each jurisdiction.

The initiative was launched last year when premiers agreed that the provinces and territories would work together to develop a national plan for oncology drugs.

“The ultimate effect is to make the decision machinery more efficient so we don't have groups of specialists sitting around the table in 13 jurisdictions coming to different decisions,” Mr. Sullivan said.

Expenditures on oncology drugs have been rising in the range of 20 to 25 per cent per year in the last few years in most jurisdictions, he said. He noted that some of these new cancer drugs can cost in the range of $30,000 to $50,000 to treat one person.

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Story 15:

J&J film takes drug ads into new territory
Reuters Health - Feb. 14, 2007
By Julie Steenhuysen - Exclusive

CHICAGO (Reuters) - Johnson & Johnson, one of America's major drug companies, will soon introduce a new genre of advertising in the form of a documentary film about inflammatory diseases but some health experts say the film may blur the lines between patient education and self-interest.

J&J's big screen effort, due to debut in New York later this month, comes as critics sharpen their complaints about direct-to-consumer TV ads that play down possible side effects of drugs and drive up healthcare costs.

The 60-minute film, dubbed Innerstate, illustrates the lives of three adults dealing with psoriasis, rheumatoid arthritis and Crohn's disease -- all of whom ultimately find relief through advanced and costly biologic drugs like Johnson & Johnson's Remicade.

Michael Parks, spokesman for J&J's Centocor unit (which makes Remicade) and executive producer of the film, defended the effort. "This is definitely not a 60-minute infomercial. The intent is really to educate patients in a meaningful way," said Parks, who acknowledges growing skepticism about drug advertising.

He said traditional direct-to-consumer advertising does not provide enough time to cover complex diseases like Crohn's disease, a chronic bowel inflammation that can be debilitating. The film allows patients to discuss the process they went through before making the decision to use advanced therapies.

"Every single patient talks about the exploration -- how they tried other things that didn't work," he said. Parks said the film reflects J&J's move away from brand-specific TV advertising, noting that no drugs are mentioned by name in the film. While the film has the backing of patient support groups, the idea of a documentary produced by a drug company leaves some doctors wary.

"This is a whole new dimension in direct-to-consumer advertising," said Dr. Jerry Avorn, a Harvard researcher and author of Powerful Medicines: The Benefits, Risks and Costs of Prescription Drugs. "What makes me edgy about it is if it is going to be a commercial, you should know it's a commercial. I'm very troubled by the blurring of the lines between advertising and patient education," Avorn said.

Parks interviewed 40 patients before selecting the three portrayed in the film. He then turned the project over to producer/director Chris Valentino, who incorporated interviews with the patients, their doctors and families.

The movie will roll out in a about a dozen U.S. markets, including Boston, Atlanta, Los Angeles and Chicago. Schedules for the free screenings at regular movie theaters will be listed on the Web site, www.myinnerstate.com, and be followed by a health fair in the theaters featuring local experts on the diseases discussed in the film.

Marc Freed, an Illinois pediatrician who has seen patients with all three disorders, said J&J may do some good in boosting awareness of the conditions, but he expressed caution. "They do have an interest in this," he said.

From an advertising perspective, the movie approach is a cost-effective way to reach a targeted audience, said branding expert Alan Siegel of Siegel & Gale in New York.

"It's fairly intelligent, but I don't think it's a documentary," Siegel said. "I'm all for anything that educates people, but if you are going to do a documentary, do a real one. Give someone some money and... don't have any say about what's in it," he said.

J&J's movie push comes at a time of increasing competition in the market for therapies like Remicade, which is part of a group of drugs that suppress tumor necrosis factor-alpha, a protein that plays a key role in inflammation. The drug costs from $18,000 to $21,000 a year.

Other drugs in the class include Amgen Inc.'s Enbrel and Abbott Laboratories Inc.'s Humira. All carry warnings about the possibility of malignancies or serious infections.

"These are very good drugs and used correctly, they can make a big impact," Harvard's Avorn said. "But I'm old fashioned enough to think whether or not to use a drug like Remicade ought to be the decision of the doctor and not because a patient saw a movie."

Copyright © 2006 Reuters Limited.

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Story 16:

Five Tips to Boost Your Email Productivity

Email is driving us all crazy!  Here are some tips that should add hours to your days, weeks or months!

Turn off Automatic Send/Receive
Many of us are distracted by our received e-mails -- they appear at all times of the day! By turning off the automatic send/receive option, you can start to manage when you receive your e- mail., rather than having it managing you.

Schedule times to receive e-mail
By selecting an option whereby you receive your e-mail every hour, or even every two hours, you will be able to consolidate your work. Very little is truly urgent; those urgent items are usually handled by telephone or personal visit. If you feel uncomfortable going for two hours without receiving e-mail, watch your e-mail for a few days to see if and when any of those critical items you might have missed, by waiting an hour, show up, then decide how long  can go between scheduled receives.

Minimize e-mail interruptions
When you recognize that every time you look up to check e-mail, it is most likely an interruption of the task you are currently performing, it will help you understand how much time not only e-mail, but the interruption is taking from your day. It is common belief that it takes at least four minutes to recover from any interruption, so if you are constantly looking at your e-mail, you are constantly interrupting yourself, and could possibly be adding unnecessary HOURS to your day or week.

Use the subject line more effectively
By putting detailed information in the subject line, you will enable others to properly sort their work. Many of us have a tendency to use a general subject, such as "Tuesday Meeting." Instead, your subject may be more effective if it states "Please bring the attached handout to the Tuesday meeting."

Unconventional use for auto signatures
You can use the auto signature feature of your e-mail program to not only insert an auto signature, but you can use it for any sentences or paragraphs you might use regularly. While you can use your primary signature as your default signature, you can create many others for situations such as this. As an example, if you have recently changed your address, and you know you will occasionally need to notify people of that address, you can create an auto signature with the new information, and simply insert it into the body of your e-mail message. This saves a lot of keying!

Copyright, Marsha D. Egan, CPCU, ACC, President the Egan Group, Inc., http://marshaegan.com. Marsha is a certified success coach and professional speaker, specializing in leadership development and positive change. You ca