The EHR Agenda in Canada

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1 The EHR Agenda in Canada IHE Workshop June 28, 2005 Dennis Giokas, Chief Technology Officer

2 Agenda Background on Canadian Healthcare System About Canada Health Infoway Interoperable EHR Solution Definitions and Concepts Canada Health Infoway Investments Importance of Standards and IHE to the Interoperable EHR Agenda Demonstration, Interoperability and Usability Lab 2

3 Overview of the Canadian Healthcare System Publicly financed health care system that supports over 31 million people Healthcare is delivered by 14 federal, provincial and territorial jurisdictions Healthcare is constitutionally a provincial/territorial responsibility YT NT NU NL The Plans are guided by 5 national principles set at the federal level Public Administration Comprehensiveness Universality Portability Accessibility BC AB SK MB ON QC NB PE NS 3

4 70% of funds from public sources Total Canada Healthcare Spending = $130 billion, 10.1% of GDP Source of Funds Private: insurance/other $19.7B 15% Public $91.1B 70% Private: out of pocket $19.5B 15% Source: Canadian Institute for Health Information, National Health Expenditure Trends, 2004 forecast 4

5 Recognizing the Need for EHRs Late 1990s Growing F/P/T consensus on the need for interoperable electronic health record systems via Canada Health Infoway Report and pan- Canadian Health Infostructure Tactical Plan Canada Health Infoway launched in late 2000 Canada s First Ministers unanimously agree to work together to strengthen a Canada-wide health infostructure. Independent, not-for-profit corporation equally accountable to 14 F/P/T government Governed by a Board of Directors (public and private sector, providers) $1.2B Capitalization since inception $500M - Electronic Health Records focus (initial funding) $600M - Accelerated EHR and Telehealth (March 2003) $100M Health Surveillance Systems (March 2004) 5

6 Infoway s Mandate Mission To foster and accelerate the development and adoption of electronic health information systems with compatible standards and communications technologies on a pan-canadian basis, with tangible benefits to Canadians. To build on existing initiatives and pursue collaborative relationships in pursuit of its mission. Goal Infoway s plan is to have an interoperable EHR in place across 50 percent of Canada by the end of Core Business We invest with public sector partners to develop, replicate and re-use compatible electronic health systems, thereby leveraging public funds, knowledge and results across Canada, to build a safer, more efficient healthcare system. 6

7 Infoway s Role is as a Strategic Investor Infoway s role as an investor focuses on initial investment in a solution & its deployment. Our unique role is in providing strategic leadership. Funder Strategic Investor Intervener Developer Fund & ignore Invest, advise & monitor Work alongside & take over if needed Write code & build modules Grants funding Is uninvolved in project execution Checks on status of phase-based deliverables Invests with Partners Involved in project planning Monitors progress of projects and quality of deliverables Gated funding approach allows management of risk Infoway also provides leadership in setting the strategic direction & standards for EHR deployment across Canada Invests with partner Involved with partner in planning, and execution Ensures success through ongoing, active participation or intervention when something goes wrong Infoway is Not A Granting Agency A Venture Capital Fund Invests independently Engages potential partners in needs analysis and testing Aims for speed and success by working without a partner or on behalf of a future partner A builder, direct implementer or holder of proprietary solutions 7

8 Infoway Architecture and Standards Role and Investment Policy Infoway s role Set standards and requirements for robust, open, standards-based interoperable solutions Mandatory Investment Eligibility Requirements Program Strategy Compliance to architecture guidelines The EHRS Blueprint Compliance to standards HL7 V3 Formal interoperability standards 8

9 Strategic Investment Programs End-user Adoption and Setting the Future Direction The Electronic Health Record Innovation & Adoption - $60m Interoperable EHR - $175m Domain Repositories and Healthcare Applications Drug Information Systems $185m Laboratory Information Systems $150m Diagnostic Imaging Systems $220m Public Health Systems $100m Telehealth $150m Cross Program Components Client, Provider and Location Registries - $135m Architecture and Standards Infostructure - $25m 9

10 Key Definition: EHR EHR An Electronic Health Record (EHR) provides each individual in Canada with a secure and private lifetime record of their key health history and care within the health system. The record is available electronically to authorized health care providers and the individual anywhere, anytime in support of high quality care. This record is designed to facilitate the sharing of data across the continuum of care, across healthcare delivery organizations and across geographies. 10

11 Summary of Key EHRS Architecture Concepts Data and Data Services EHR and domain repositories are patient-centric, lifetime, federated databases All clinically relevant data that needs to be shared Encounter information Structured, integrated and semantically consistent Public Health repositories to support outbreaks Registries to identify people, providers and locations of care Health Information Access Layer (HIAL) Standards, common and communications services to integrate applications across the continuum of care and healthcare delivery jurisdictions Enables integrated access and view Creates data and application abstraction layers Most cost effective approach to integration Applications Clinical data to share is pushed from source systems into EHR in near real time EHR data is pulled into the provider s application for one integrated view Registry Services H I A L EHR Solution (EHRS) Public Health Services Applications EHR Data & Services Continuity of Care Data Common Services Communication Bus Communication Bus Domain Repository Services Appl Appl Appl Appl 11

12 Healthcare Provider s View of EHR EHR Solution (EHRS) Client Registry Provider Registry Continuity of EHR Care Data Domain Repository (Lab) Domain Repository (Pharmacy) Domain Repository (Diagnostic Imaging) HIAL Common Services Communication Bus Patient Info Applications EMR Patient History Laboratory Drug Profile Diagnostic Imaging Public Health Telehealth 12

13 IHE Profiles Required in DI Investments Scheduled Workflow Patient Information Reconciliation Consistent Presentation of Images Presentation of Grouped Procedures Key Image Note Portable Data for Imaging 13

14 DI and Registries Interoperability Profiles Provincial DI Repositories (DI-r) require solutions for interoperability Sharing of DI data between multiple PACS and RIS Integration with client registries to facilitate patient cross referencing Integration with provider registries to facilitate identity management and support privacy controls Currently, Infoway is leveraging the IHE framework, in particular the Cross Enterprise Document Sharing (XDS) profile IHE XDS for imaging (XDS-I) Interoperability Profile August 2005 Infoway team members are the prime author of this profile Leverage the IHE Radiology Committees to develop the Interoperability Profile Reference implementation January

15 EHR Collaboratory - Vision & Objectives Vision A network of interoperable EHR systems in a virtual and physical lab environment that can be used for stakeholder demonstration, as well as assessing usability and adoption Objectives Interoperability Demonstrate and evaluate that a large number of disparate information systems from different vendors can talk to one another using accepted standards so that clinicians can securely access a person s entire health information from anywhere in Canada Usability - Demonstrate and evaluate that the systems being deployed can be easily used by clinicians to support the provision of quality health care. Adoption - Identify and assess the complex human factors related to clinicians actually using and obtaining value from EHR systems in their daily practice, especially primary care physicians. 15

16 Scope of the Project In Scope Demonstrate the EHR within Infoway s mandate Interoperability among domain components Pan-Canadian interoperability Demonstrate innovations outside of the mandate of Infoway, e.g. Chronic disease User interface devices Medical devices with a tie-in to the EHR Not In Scope Performance and Scalability Conformance and Compliance Procurement Functional Testing, i.e. user acceptance testing 16

17 What is the Collaboratory? A physical space that can simulate clinical environments and healthcare processes Exists inside a health system Has the only health specific usability capability in Canada Enriches the experiences for the users and those assessing those experiences Scenario based Independent Multi-vendor approach Infrastructure for interoperability, usability and adoption testing 17

18 Summary EHR systems are seen as key to a safer, cost-effective healthcare network Interoperable EHRs in place across 50 percent of Canada by end of 2009 Tangible value is being delivered as we proceed, focused on Registries Diagnostic Imaging Systems Drug Information Systems Laboratory Information Systems Telehealth Public Health Surveillance Interoperable Electronic Health Record EHR securely integrates data from varied clinical information systems Standards are key for semantic interoperability Privacy is addressed in everything we do Healthcare community support and adoption are key to our success 18

19 Thank You!

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