Canada ehealth Data Integration Snapshots

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1 Canada ehealth Data Integration Snapshots Collection, Integration, Analysis of Electronic Health Records for Monitoring Patient Outcomes Liam Peyton

2 Agenda Electronic Health Records Why are they so hard to build? Or are they? Data Integration Snapshots from the Canadian Landscape TOH, PAL-IS, Ottawa Heart Institute, Oscar, MyOscar, Telus HealthSpace, IDS, Manitoba Centre for Healthcare Policy Drivers that enable integration Recommendations

3 Electronic Health records EHR Collection of relevant health information for a patient (file) A piece of structured health information for a patient that can be communicated to another health care professional Integrated audit log of health service events for patient(s) Log of official events or all events or relevant events? Purpose Transmission of medical information between providers Quality of care provide data needed for informed healthcare decisions monitor care (manage and improve) EMR: Health records of a single healthcare provider PEHR: patient view or patient log of personal health care events

4 Is it hard? Yes!! Billions spent without measureable results Canada Health Infoway ~$2.5 Billion Ontario ~$1Billion Quebec ~$.5 Billion Kaiser Permanente ~$1Billion (~$4Billion later succeeded) No!! They already exist OHIP Billing Database Quebec Pharmacy Records, ER Visits Many big hospitals Kaiser Permanente IDS, Canada Surveillance

5 International Society for Disease Surveillance

6 Data Feeds for Influenza like Illness Monitoring Some ER departments in US now provide a real-time or daily HL7 data feed to local public health authority Some process & generate a feed to regional, federal, international (secure FTP, data received varies ) Hospital Unique Id, Diagnosis, Age, 3 Digit zip(whose?), Disposition (Fever, Hospital etc.) Issues Federal, local turf wars (cities vs states vs regions) Fear of publicity, protect hospitals Data Quality, Neighbouring hospitals in different regions Only city in Canada to participate is Kingston talks with Ottawa, Montreal Toronto does not have a syndromic system at all

7 Canadian Landscape Health Data Orgs Most are health data researchers associated with Universities Population Data BC (UBC) Health Care Quality Center (Sask. Health, U. of Sask.) Alberta Health Services Manitoba Center for Health Policy (U of Man.) ICES (Toronto, Ottawa Hospital Research Institute, uottawa) Clinical and Health Informatics Research Group (Mcgill) New Brunswick PHRU (Dalhousie) Newfoundland Center for Health Information All experience severe delays getting access to data (1 year not unusual) except where researchers are Ministry of Health employees (Saskatchewan)

8 MCHP Concept Dictionary & Tools

9 MCHP Lupina Foundation Research unit within the Department of Community Health Sciences in the Faculty of Medicine at the University of Manitoba. from the MCHP Accreditation: Introduction module

10 Population Health Res. Data Repository

11 Ottawa Hospital Research Institute Embedded research institute associated with uottawa TOH Data warehouse for entire hospital used by researchers who are also clinicians Performance Management initiative: Quality of Care Adverse events converted into continuous improvement of health care processes Hospital Performance Measurement Indicators Dashboard Antibiotics usage, C. Difficile, Hip fractures patients over 65, mortality rate, post-operative infections etc. Bridge the gap from data analysts and their understanding of source databases and data warehouse and clinicians/administrators Screen shots that follow are a uottawa prototype, unrleated in terms of content to what is deployed in hospital but similar in approach

12 Performance Management Portal Key Metrics News Feed Antibiotics Tracking Important Links Campus Dashboard

13 Drill into Surgery Drill into Most Prescriptions Evolving E-Health Business Processes Around Accessible Data Warehouses

14 Integrating Data Warehouse Data Marts End-User Access Operational Feedback Data Warehouse Data Extraction & Transformation Operational Systems Data Extraction & Transformation

15 TOH Data Accessibility Data Warehouse Datamart Reports Sources Datasets Access Controls Analysts Indicators, Variables Datasets, Inclusions/Exclusions Trends, Decisions, Analysis Users Metadata Dictionary Documentation Access Requests

16 Data Mart Extract For Infection Control

17 Ottawa Hospital Team of 5-6 researchers and data analysts have a rich set of integrated data to mine Other researchers have 6 month wait time for access Communicating to TOH community via portals in its infancy Challenge Timeliness and availability of data in warehouse Integration of non-warehouse data Ensuring and documenting data processing & data quality Learning dashboarding technology Getting community buy in, Enabling Community Access Future Inpatient/outpatient hand off Patient access External to hospital research community

18 Other Initiatives Oscar, Open source EMR for physicians Hundreds, thousands across Canada especially Hamilton MyOscar Harvard-MIT Children's Hospital Informatics secure, private on-line health record. Patient has total control as to who can put information into your record and with whom information shared. communicate securely with your health care team request copies of your records from your doctor which may be lab results, prescription profile, or scanned documents manage your prescription renewals make appointment requests or cancel appointments access reliable health information about topics of interest

19 Other Initiatives Telus HealthSpace Free PEHR With open api for vendors, organizations to interface Telus plus Microsoft Users can grant access to physicians, institutions to add entries (e.g. discharge summary from hospital) Claims Canadian Infoway compliant and complementary Met with 11 Privacy Commissioners plus CIPPIC Microsoft Health Vault, Google Health (Mount Sainai) in US Different rules Data analyzed and sold similar to Google mail

20 Drivers to Enable Data Integration Reimbursement (OHIP) or Make Money from Data Medical Crisis (Epidemics, Canadian Blood Services) Medical Research (TOH) Data Feeds Available Organizational Mandate (Saskatchewan, Hospitals) Performance Management Quality of Care Ethical & Privacy Review Boards Permission / Desire (patients, doctors, institutions) Technical Capability of Physicians & Patients

21 Recommendations Organizational (Real-time Feeds and Transparency) Establish commitment (duty?) of controlling institutions and governments to provide real-time, transparent streamed healthcare event data to government/private/consumer with a broad definition of care (include community of care), and research (include publication in a variety of media) Technical (Datamarts and Dashboards) Develop a framework for filtering, transformation and prepackaging of data according to systematic security domains, user groups and roles with accountability and responsibility Development of end user access and delivery experience.

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