5.     How can a rigorous set of SLAs or benefits related to technology, resources, change management, and other aspects of the whole system be related to patient outcome?

Much discipline is required by the organization to provide adequate sponsorship from the clinical, staff, administrative and executive stakeholders and users.  The clinical and statistical outcomes should be to the extent possible setup as quantifiable measurements and made as tangible as possible.  Careful planning will have to be undertaken by not just technologist but by end users who will take ownership of the end solutions and new clinical / business processes.  There must be strong leadership and their must be buy-in by all to effectuate the changes needed to make the appropriate use of technology succeed.  The greatest benefits of technology are not in the first implementation (which is most often very painful) it is in the ability to appropriately share, decimate and reuse information.  One of the main reasons health informatics implementations are so far behind this that it is such a painful and complex process to start this implementation process.  There are so few organizations who do it 'right' or stick with it to get the integration benefits. 

There have to be new measurements - Service Level Agreement's (SLA), charters or contracts put in place between user departments, health administrators, vendors and the government to get long term results which are based patient, clinical and commercial outcomes.  These are not just dollar and cents contracts, these are long term performance agreements which are based on subjective and objective measurements, outcomes and results. 

4.     What are the real business drivers for health informatics, when there have been no demonstrated benefits?

Opportunities for vendors, but I’m hearing that a number of them want to abandon the health care marketplace as the opportunity costs and indecision are too at too high a cost.

3.     Is the EHR the Holy Grail?  How would you move the quest for it forward?  Are there other areas to concentrate on now?

No – the problem is really not much different than constructing complex spreadsheets or large databases of accounting and transaction records from data.  The Banks have figured it out in allowing customers to download critical data into your favorite spreadsheet or accounting program. We really need to look at how similar issues have been handled in other sectors – it’s all about getting back to basics.  There has been a solid infrastructure build here in Ontario through the Smart Systems for Health Agency.  There must be a strong commitment from all levels and all disciplines to 'make things happen'.