Creating a national electronic health record: The Canada Health Infoway experience Presentation by Dennis Giokas Chief Technology Officer, Canada Health Infoway October 11, 2007
Overview The need for EHR in Canada Infoway s mission, approach, programs Architecture and Standards Progress across Canada Value to stakeholders Challenges and opportunities 2
Great expectations What Canadians expect from their healthcare system: Accurate information that moves with them Communication between their various healthcare providers Protection of their privacy Input into decisions Elimination of undue risk Timely access/results EKOS survey 3
The need for EHR For every 1,000 hospital admissions 1,000 patients with an ambulatory encounter 1,000 patients discharged from hospital 1,000 laboratory tests performed 1,000 emergency department visits 1,000 Canadians recommended for influenza protection in Canada 75 people will suffer an adverse drug event 20 people will suffer a serious drug event 90 people will suffer a serious adverse drug event up to 150 will be unnecessary (range 50-150) 320 patients have an information gap identified, resulting in an average increased stay of 1.2 hours 370-430 are not vaccinated McKinsey & Company Canadian Institute for Health Information 4
The need for health information management Consumerism is growing Providers, managers, patients, public are demanding more Population is aging Pressures on resources are greater IT has potential to enable solutions to address pressures Care settings are shifting 5
The interoperable 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 healthcare 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. 6
Access to detailed data Other Clinical Data Patient Information Medical Alerts Medication History Interactions Problem List Immunizations 7
Interoperability challenges 700 hospitals 40,000 general practitioners 315,000 nurses 29,000 specialists 26,000 pharmacists 1,600 long-term care facilities 8 8
Benefits of EHRs Quality Better continuity of care improves disease and case management Appropriate care adheres to standards Prevention of adverse events and public health threats Improving quality improves health, reduces the burden on the system, and ensures optimal use of capacity. Productivity Immediate access to clinical data saves time Avoids unnecessary diagnostics, procedures and visits Optimizes coordination of human resources Improving the productivity of health care saves costs and makes optimal use of available human and other resources. Access Timely delivery of care Increased interpretations by remote specialists Improved wait-times for diagnostic imaging services Improved availability of community-based health services Reduced patient travel time and cost to access services Increased patient participation in home care Increased patient access and use of their health record Capital cost : $10 billion to $12 billion Benefits: $6 billion to $7 billion in savings annually Reduced wait times 9
Infoway s mission, approach, programs 10
Canada Health Infoway Created in 2001 $1.6 billion in federal funding to date Independent, not-for-profit corporation Equally accountable to 14 federal/provincial/territorial governments 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. Goal: By 2010, every province and territory and the populations they serve will benefit from new health information systems that will help modernize their healthcare system. Further, 50 per cent of Canadians will have their electronic health record readily available to their authorized professionals who provide their healthcare services.
Infoway s role as strategic investor Infoway invests strategically with public sector partners to develop, replicate and re-use compatible electronic health systems, thereby leveraging public funds, knowledge and results across Canada. 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 Invests with partner Involved with partner in planning, and execution Ensures success through ongoing, active participation or intervention when something goes wrong 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 Infoway also provides leadership in setting the strategic direction and standards for EHR deployment across Canada 12
Infoway business strategies Participate in healthcare renewal Collaborate with our partners Target the investments Support solution deployment Promote solution adoption and benefit realization 13
Infoway programs Ten investment programs totalling $1.636 billion End-user Adoption and Setting the Future Direction Innovation and Adoption $60 million Innovation and Adoption - $60 million* Healthcare Applications and Innovation Projects Telehealth $100 million Public Health Surveillance $135 million Patient Access to Quality Care $50 million Cancer Primary Care Chronic Diseases Mental Health The Electronic Health Record Interoperable EHR $365 million Registries and Domain Repositories Registries $134 million Drug Systems $250 million Laboratory Systems $170 million Diagnostic Imaging $340 million Architecture and Standards Infostructure $32 million
Focus on standards and interoperability Common architecture accepted by jurisdictions and vendors Architecture defines privacy and security enhancing services Comprehensive standards collaboration process New Infoway Standards Collaborative for support and maintenance 15
The EHR architecture JURISDICTIONAL INFOSTRUCTURE Registries Data & Services Ancillary Data & Services EHR Data & Services Data Warehouse Client Registry Provider Registry Immunization Management PHS Reporting Shared Health Record Drug Information Diagnostic Imaging Laboratory Health Information Location Registry Business Rules EHR Index Message Structures Normalization Rules Terminology Repository Longitudinal Record Services Security Mgmt Data Privacy Data Configuration HIAL Common Services Communication Bus Public Health Services Pharmacy System Radiology Center PACS/RIS Lab System (LIS) Hospital, LTC, CCC, EPR Physician Office EMR EHR Viewer POINT OF SERVICE Public Health Provider Pharmacist Radiologist Lab Clinician Physician/ Provider Physician/ Provider Physician/ Provider 16
Electronic health records: Linked jurisdictional networks Distributed, message-based, peer-to-peer network of EHRS systems EHRS EHRS EHRS EHRS EHRS EHRS EHRS 17 17
Connecting Standards in Canada Over the last 2 years, Canada has completed a major governance transformation initiative, bringing together a complex health information standards community into a single cohesive, coordinated collaborative. This new governance model integrates committees (~50% reduction), organizations, process and services across numerous standards SDOs and domains to provide a single point of contact for coordination of Pan-Canadian standards throughout the standards life cycle. SCC CSA Technical Sub-Committee Infoway Standards Collaborative Strategic Committee Standards Collaborative Coordinating Committee CIHI Clinical Sub-Committee pcsg SCWG #1 - Population Health (Delivery of Care) SCWG #4 - Medication Management SCWG #7 - Non- Clinical Registries pcsg SCWG #2 - Individual Care (Delivery of Care) SCWG # - Labs & Diagnostics SCWG #8 - IT Privacy & Security Services SCWG #3 - SCWG #6 - Terminology Managing the Health Infostructure & Representation & System Architecture Services 18 2007 Canada Health Infoway Inc. SCWG #9 -
Standards Collaborative Scope Coordination of Pan-Canadian standards throughout the standards life cycle: development, implementation support, education, maintenance and conformance Support for EHR pan-canadian messaging, terminology and interoperability profile standards Domestic secretariat services to support:» HL7 Canada» SNOMED CT National Product Centre» Canada s ISO committees (CAC/Z295) with CSA» LOINC» The Partnership for Health Information Standards Liaison roles to the following Standards Development Organizations:» IHTSDO» HL7 Inc» DICOM» LOINC» ISO/TC215» IHE and IHE Canada 2007 Canada Health Infoway Inc. 19
Standards Life Cycle Needs Identification & Business Definition Options Research and Analysis Standards Selection Strategy Maintenance Standards Development Pan-Canadian Standards Conformance Test Pilot Stable for Use Implementation Support Training Education Final Approval 2007 Canada Health Infoway Inc. 20
Integrated & Coordinated pan-canadian Standards Services Client Services & SDO Relations Client Services Information Desk Membership Management Conferences SDO Relations Formal & Informal SDO Liaison Distribution & Rights Management Govern and manage SDO Affiliates Standards Collaboration Process Services Overall Process Management and Improvement Stakeholder Collaboration & Engagement Knowledge Management Benefits Evaluation Standards Adoption Strategies Promotion & Communications Change Management Clinical Alignment & Support Maintenance Services Ongoing standards sustainability and relevance Prioritize, fund and deliver maintenance of Infoway-developed standards Conformance Services Develop Conformance strategy & governance Promote adherence to Standards Develop & publish conformance criteria Liaison with ehealth Collaboratory Implementation Services Implementation resource development Implementation acceleration & support services Stable For Use Standard quality validation & promotion Development Support Development Strategy Development Alignment of Development principles, approaches and deliverables Education & Training Development of Training materials & programs Provision of general and specific standards education Outreach training services 2007 Canada Health Infoway Inc. 21
Architecture & Standards Portfolio for EHRS - $51M Investment to Date Architecture & Terminology Standards EHRS Blueprint EHR Use Cases EHR Data Model EHR Services Model EHR Interoperability Profiles Terminology Standards Strategy Terminology implemented in data messaging standards Data Messaging Standards Client Registry (stable for use) Provider Registry (stable for use) Pharmacy CeRx (stable for use) Laboratory (stable for use) Diagnostic Imaging/Teleradiology (stable for use) iehr Clinical Messaging (stable for use) iehr Technical Standards (in development) Public Health Surveillance Standards (in development) 2007 Canada Health Infoway Inc. 22
March 2004 = $123 million 53 projects June 2007 = $1.203 billion 233 projects Phase 0/1 Projects Phase 2 Projects System in place
Infoway is adding value at every step Joint governance Joint planning Predictable funding Common solutions architecture Common ICT standards Accountable spend Common procurement Common solutions National pricing Shared services Knowledge sharing Global leaders exporting expertise A mid-term independent performance evaluation conducted in 2005 and a 2006 review commissioned by Health Canada both validated and supported Infoway s value-added role. 24
The next generation of health care systems Foundation systems Electronic health record for 100 per cent of Canadians Electronic medical record for primary and ambulatory care Hospital Information Systems CPOE and advanced decision support Patient portals to permit patients to view their electronic health record Business systems Public health for comprehensive pandemic management Chronic disease management for advanced case management of key chronic diseases such as diabetes, congestive heart failure, and cancer Wait time management to allow electronic referrals, enterprise scheduling and wait time monitoring and reporting Patient self care to support patients and their care givers in the home Performance management to ensure sustainable patient care delivery 25
Priorities to 2015 Additional Elements Foundational Elements 1 2 3 4 5 Finish what started in electronic health records and public health surveillance Implement electronic medical records in physician offices and physician order entry systems in hospitals Enable public visibility for wait times and access Facilitate patient self-care and empowerment Trial and perfect more advanced functionality in wait times and chronic disease management Largest investment required 26
Hurdles to overcome Clinician adoption/patient engagement Jurisdictional capacity Interoperability Vendor adoption Recapitalization 27
The promise Increased patient participation in care Well-managed chronic illness Improved access to care in remote and rural communities Fewer adverse drug events Better prescribing practices Reduction in duplicate or unnecessary tests Reduced wait times 28
Thank you!