Canada Health Infoway and the Electronic Health Record

1
Canada Health Infoway and the Electronic Health
Record

• Impacts Opportunities
• Robert (Bob) Burns
• AFMC
• May 8, 2007

2
(No Transcript)
3
Overview

• Why the EHR?
• Why what is Canada Health Infoway?
• Progress to date
• Challenges hurdles
• Benefits
• EHRs and Education

4
The Need Patient Expectations
5
Managing ExpectationsWhat are the Jones
expecting from their healthcare system?

• Accurate information moves with them
• Various providers communicate with each other
• Privacy is protected
• Decisions are made in consultation with them
• Not exposed to undue risk
• Receive timely access/results
• Can access their own EHR
• Have the ability to learn on their own, with
  assistance from their healthcare providers

6
The Need for EHR
For Every . . in Canada
1000 hospital admissions 75 people will suffer an Adverse Event
1000 patients with an ambulatory encounter 20 people will suffer a serious Adverse Drug Event
1000 patients discharged from hospital 90 people will suffer a serious Adverse Drug Event with the drugs received on discharge
1000 Laboratory tests performed up to 150 will be unnecessary (range 50-150)
1000 Emergency Department visits 320 patients had an information gap identified, resulting in an average increased stay of 1.2 hours
Study of 168 traditional medical records 81 didnt have the information required for patient care decisions
1000 women at risk of cervical cancer 300-400 are not screened
1000 Canadians recommended for influenza protection 370-430 are not vaccinated
7
Growing Need for Health Information Management
10
Resource pressures intensifying
Resource pressures greater

• Providers, managers, patients, public are
  demanding more
• IT has potential to enable solutions to address
  pressures

Care settings are shifting
Consumerism is growing
Population is aging
Source CIHI Sanofi-Aventis Statistics
Canada OECD WHO Centre for Chronic
Disease Prevention
8
Yet Canada Invests Less in Healthcare IT than
Other Information-intensive Businesses
5.4
Annual IT spend Percent of total
budgets/revenues
5.4

• Canada is underinvesting in IT relative to other
  healthcare providers and information management
  industries
• Canadas healthcare system would rank No. 10 in
  the Fortune 500 and is 3 times the size of the
  Royal Bank and has limited ability to manage its
  information
• Additionally, investments have often been
  fragmented and one-off leading to duplication of
  efforts and need for reinvestments

4.7
4.5
4.0
3.4
2.9
Range of HC IT spend of Canadian jurisdictions
2.0
1.5
Education
US HC providers
UK health-care
Professional services
US banking/ financial services
Calgary Regional Health Authority
Operating and capital Gartner estimate as
of revenues assumes providers working on a
non-profit basis Predicted rise to 4 from
1.5 in 2004 Sources Information Technology
Association of Canada, 2004 Gartner
9
EHR Defined

• An electronic health record (EHR) is a secure and
  private lifetime record of an individuals health
  and care history, available electronically to
  authorized health providers. It facilitates the
  sharing of data across the continuum of care,
  across healthcare delivery organizations and
  across geographies.

9
6
10
10
11
EHR and EMRand convergence

• An electronic health record (EHR) is a secure and
  private lifetime record of an individuals health
  and care history, available electronically to
  authorized health providers. It facilitates the
  sharing of data across the continuum of care,
  across healthcare delivery organizations and
  across geographies.

• An electronic medical record (EMR) is a provider
  or site specific record of the interactions with
  a specific patient. By definition it is not
  complete, although it may be more richly detailed
  in some aspects than an EHR. It is maintained by
  providers to meet their fiduciary duties to their
  patients, as well as the requirements of their
  regulatory bodies.

12
The Model/Vehicle to Begin to Address Need
Canada Health Infoway
13
About Infoway

• 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
• Approach
• Infoway was established by the First Ministers of
  Canadas federal, provincial and territorial
  governments in 2001
• Infoway is a not-for-profit corporation
• Funded by the Government of Canada, funding was
  allocated to Infoway in 2001 (500m), 2003
  (600m) and 2004 (100m)
• Infoways members are Canadas 14 federal,
  provincial and territorial Deputy Ministers of
  Health
• Independent Board

14
Infoway Business Strategies

• Targeted Investment Programs
• Limited scope - goal
• Collaboration with health ministries and other
  partners
• Co-Invest with public sector partners (7525
  formula)
• Leveraged investment
• Form strategic alliances with the private sector
• Manage risk and ensure quality solutions
• Focus on end-user acceptance
• Measure benefits and adjust

15
Infoways Programs
Infoways Goal By the end of 2010, some
elements of the basic EHR will be in place for
all Canadians, while a complete basic EHR will
be in place for 50 of Canadians. All
Canadians will benefit from better healthcare
access, quality and productivity.
Innovation and Adoption 60 million
Innovation and Adoption - 60 million
Chronic Disease
Wait Times
Cancer
Public Health Surveillance 100 million
Telehealth120 million
Etc.
Primary Care
Patient Safety
Mental Health
Interoperable EHR 175 million
Basic Elements of EHR
Diagnostic Imaging 310 million
Laboratory Systems150 million
Registries 134 million
Drug Systems185 million
Infostructure 32 million
16
Focus on Standards and Interoperability

• Common architecture largely accepted by
  jurisdictions
• Revised architecture includes privacy and
  security
• Comprehensive standards collaboration process
• New Infoway Standards Collaborative

17
EHR Conceptual Architecture
Longitudinal Record Services
Common Services
Communication Bus
JURISDICTIONAL INFOSTRUCTURE
Registries Data Services
DataWarehouse
EHR Data Services
PHS Data Services
DiagnosticImaging
Laboratory
HealthInformation
DrugInformation
SharedHealthRecord
ClientRegistry
PHSReporting
OutbreakManagement
ProviderRegistry
LocationRegistry
MessageStructures
EHRIndex
BusinessRules
NormalisationRules
TerminologyRegistry
SecurityManagement Data
PrivacyData
Configuration
HIAL
EHR Viewer
Physician/Provider
Physician/Provider
Physician/Provider
Public HealthProvider
Lab Clinician
POINT OF SERVICE
18
Electronic Health Records
Linked Jurisdiction Networks

• Distributed, Message-based, Peer-to-Peer Network
  of EHRS Systems

19
Progress to Date
20
Program Activity Summary
217 active completed projects valued at 1,133
M in all 9 investment programs

• Legend
• ? Registries
• ? Diagnostic Imaging
• ? Drug Info Systems
• ? Lab Info Systems
• ? Telehealth
• ? Interoperable EHR
• ? Public Health Surv.
• ? Innovation Adoption?Number of Projects

The 135 projects jointly developed with provinces
and territories are shown. In addition, there
are 82 active or completed pan-Canadian projects.
21
Significant Progress in 3 Years
March 2004 125 M
September 2006 825 M
WEST
ON
QC
EAST
TERRITORIES
WEST
ON
QC
EAST
TERRITORIES
WEST
ON
QC
EAST
TERRITORIES
2005-06
NU
NT
NS
PE
NL
YK
MB
NB
SK
AB
BC
Public Health
Telehealth
Telehealth
9
iEHR
Laboratory
INVESTMENT PROGRAMS
Drug
DI
Provider Reg.
Client Reg.
22
Different Stages of Progress
23
Leveraging the EHR for Innovative Health Care
24
Infoway Adding Value at Every Step

• Joint governance
• Joint planning (rolling 3 years)
• 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 recent review
commissioned by Health Canada both validated and
supported Infoways value-added role.
25
The Global Scene
The International Milieu
A number of nations have made significant
e-health progress, with widespread EMR adoption,
electronic communication and data sharing (e.g.
lab results).
10 -
Canada and the UK lag slightly behind some others
in EHR progress New Zealand, Denmark, Norway
and the Netherlands. However, both Canada and the
UK have strong focused national strategies and
significant resource commitments to provide these
nations the momentum to become the global leaders
in the next 3 years.
5 -
Progress (EHR Implementation plus Adoption scores)
The US and Australia currently lack momentum
towards an EHR. Both have national strategies
but currently lack the funding to successfully
execute the strategy. With funding both could
quickly join the leading nations.
5 -
10 -
Momentum (Strategy plus Resources scores)
This graphic is based upon analysis prepared by
Infoway using publicly available documentation on
international EHR initiatives. All findings are
subjective in nature.
26

• Before we get too smug
• On the road to 2015

27
The Road to 2015

• To develop a Health Infostructure Plan for Canada
  that confirms the long term vision and details
  the strategic directions that the country should
  consider over the next 10 years, including the
  associated resource requirements.
• To provide a roadmap for the complete
  implementation of the electronic health record
  across the country as well as the extension of
  the infostructure to support all aspects of
  healthcare renewal.

28
The Vision

• Foundation Systems
• Electronic Health Record for 100 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 Selfcare to support patients and their
  care givers in their home
• Performance Management to ensure sustainable
  patient care delivery
• Capital Cost 10 to 12 billion
• Benefits 6.0 to 7.6 billion annually

29
Priorities to 2015
Largest investment required
1
Ensure baseline EHR and public health
infostructure is in place across the country
Unlock additional quality and safety benefits by
enabling decision support and communication
across care continuum
2
Foundational
3
Facilitate improvements in patient self-care
Enable public visibility into wait times
4
Additional elements
Additional Elements
Trial more advanced functionality to meet high
priority system needs
5
30
Opportunities
31
Benefits Evaluation at Infoway
32
EHR Overall Benefits Value

• Improved interpretation of diagnostic and
  laboratory results
• Decreased adverse drug events
• Decreased prescription errors
• Increased speed and accuracy in detecting
  infectious disease outbreaks

QUALITY

• Increased access to integrated patient
  information
• Reduced duplicate tests and prescriptions
• Reduced physician prescription call-backs
• Reduced patient and provider travel costs

PRODUCTIVITY
33
Infoway Benefits Evaluation Plan

• Purpose
• Assess the impact of Infoway investments in
  electronic health record solutions on healthcare
  quality, productivity and access.
• Impacts identified will be used to
• Demonstrate value of investments
• Advance further investments in EHR solutions
• Encourage end user adoption
• Highlight necessary adjustments in the Infoway
  investment strategy
• Principles
• Evaluate the Canadian experience with sufficient
  rigor to provide confidence in benefit estimates
  dont try to develop the definitive EHR
  evaluation framework
• Focus on evaluating programs that will produce
  tangible clinical benefits (Lab, Drug, DI,
  Telehealth, PHS and iEHR)
• Not all projects or activities will be evaluated.
  Identify representative sample and most
  appropriate methodologies to allow extrapolation.
• The EHR benefits evaluation will be evaluated and
  revised on an ongoing basis

34
Infoway BE Framework

• The framework articulates the link between the
  systems in which Infoway invests and the
  resulting benefits, providing a basis for
  measurement.

Based on the Delone McLean IS Success Model
35
Quality, Access and Productivity Indicators

• Change in provider effectiveness/ appropriateness
  of care
• Access to information
• Timeliness of service delivery, pharmacists,
  public health, referring physicians, radiologists
• Vaccination rates, Outbreak detection and
  intervention

• Change in patient safety
• Medication errors and Adverse Drug Events

• Change in health system outcomes
• Readmission rates
• Efficiency of recovery
• Patient transfers

• Change in patient and caregiver participation
• Patient awareness and adherence

• Change in access to services
• Volume of service provision
• Access to previously unavailable services
• Timeliness of DI services

• Change in coordination of care
• Information sharing among different providers
• Management of outbreaks
• Change in net costs
• Unnecessary events radiology, lab tests,
  vaccinations

• Change in provider efficiency
• Radiology Technologist and Radiologist efficiency
  
• Pharmacists and Lab technician callbacks
• Time to take medication history or assess patient
• Clinician workflow

36
New tools bring new questions EHR and secondary
uses of data
37
Secondary Use of Data workshop with CIHI January
2007

•  
• Time to start building and marketing the case for
  secondary use to build readiness by physicians,
  public and other stakeholders
• Need to develop detailed use cases and/or a
  higher level framework identifying requirements
  for secondary use
• Need to identify experiences, successes and
  failures, both nationally and internationally and
  build upon them

38
EHR Conceptual Architecture
Longitudinal Record Services
Common Services
Communication Bus
JURISDICTIONAL INFOSTRUCTURE
Registries Data Services
DataWarehouse
EHR Data Services
PHS Data Services
DiagnosticImaging
Laboratory
HealthInformation
DrugInformation
SharedHealthRecord
ClientRegistry
PHSReporting
OutbreakManagement
ProviderRegistry
LocationRegistry
MessageStructures
EHRIndex
BusinessRules
NormalisationRules
TerminologyRegistry
SecurityManagement Data
PrivacyData
Configuration
HIAL
EHR Viewer
Physician/Provider
Physician/Provider
Physician/Provider
Public HealthProvider
Lab Clinician
POINT OF SERVICE
39
Privacy and Security Services (Future State)
Longitudinal Record Services
Common Services
Communication Bus
JURISDICTIONAL INFOSTRUCTURE
Registries Data Services
DataWarehouse
EHR Data Services
Ancillary Data Services
DiagnosticImaging
Laboratory
HealthInformation
DrugInformation
SharedHealthRecord
ClientRegistry
PHSReporting
OutbreakManagement
ProviderRegistry
LocationRegistry
MessageStructures
EHRIndex
BusinessRules
NormalisationRules
TerminologyRegistry
SecurityManagement Data
PrivacyData
Configuration
HIAL
POINT OF SERVICE
40
White Paper on Information Governance

• Early 2007 release - for feedback comment
• Identifies the areas for dialogue
• Governance is not new how information flows with
  an iEHR is new
• Governance will require variety of approaches
• Where will responsibility for governance
  management reside?

41
Areas for Dialogue

• Trust Accountability
• Privacy Rights of Patients
• Assessment Compliance
• Quality in Healthcare
• Technical Safeguards
• Rights of healthcare providers communities of
  interest
• with subsequent sections on legal, ethical and
  professional requirements, the current mechanisms
  at play, and examples of other industrys efforts
  to come to grips with similar issues

42
Challenges
43
Several Hurdles Will Need To Be Overcome To
Complete The Existing Mandate
Journey far from complete
Urgency behind building a case for ongoing support
Front-line implementation, including standards
implementation, business process redesign, and
clinician adoption
Securing the right mix of leadership at all levels
Bring key stakeholders public and clinicians in
particular on board
Until you get a reasonable level of critical
mass, we are years away from measuring systemic
benefits to the system. This is the problem for
elected officials, who want to see the benefits
quickly. Regional CIO
We need additional champions beyond Infoway.
Deputy Minister
We need people pounding the table for this.
Regional CIO
Clinicians will not be willing to adopt the
technology if it makes their life harder.
Clinician
44
Academe as stakeholders

• Teaching, research, service delivery - and
  thought leader
• Teaching - UG,PG, CPD
• Research secondary use as discussed
• Service delivery as discussed
• Thought leader

45
Academic/Learning Advisory Group

• Role provide expert input to one of 4 key
  elements of the End User Strategy
• After D Covvy

SKILLS KNOWLEDGE ATTITUDES EXPERIENCE
CPD/KT
46
Challenges for Teaching Institutions

• Technology itself (50 of FP teaching units)
• Strategic alliances with institutions (hospitals,
  LHINs, RHAs) where care is delivered
• Theme of EHR solutions as tool, cross-cutting
  all training, rather than stand-alone or
  add-on to curriculum
• Walk the talk - clinically, and technologically

47
The Promise

• Increased patient participation in care
• Well managed chronic illness
• Improved access to care in remote and rural
  communities
• Less adverse drug events
• Better therapeutic outcomes
• Better prescribing practices
• Reduced wait times

48
(No Transcript)
49
Thank You!www.infoway-inforoute.ca