i Public Health Information System:

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i Public Health Information System
The Pan-Canadian Perspective
Layton Engwer President CEO Amaranth Consulting
Group
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What is iPHIS all about?

• Health Surveillance

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• QUALITY INFORMATION FOR PUBLIC HEALTH CAN BE
• AS EFFECTIVE AS A NEW VACCINE IN ENHANCING
• POPULATION HEALTH
• Dr. R. Brunham, U.B.C.

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The PHIS story

• Chapter 1 The Beginning
• Chapter 2 The Evolution
• Chapter 3 What it does.
• Chapter 4 Pan-Canadian Perspective
• Chapter 5 The never ending story
• Chapter 6 Good/Bad Ugly
• Chapter 7 Epilogue

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CHAPTER 1

• The Beginning

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Public Health in context

• 3 of the Health Budget
• Low man on the IT/IM agenda
• Significant changes in Governance
• Clients seek services in multiple
  jurisdictions/regions
• Focus is prevention

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In the beginning Health Canada

• 1996 Deputy Ministers Surveillance Network
  working group established
• Result 1999 final report recommended
  establishing a national integrated Surveillance
  network and associated common policy and skill
  sets
• No legislation or mandated reporting to HC.
• Result HC had to negotiate with P/Ts to share
  information for national surveillance.

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In the beginning The Need

• In 1999 the Auditor General examined the way in
  which Health Canada carried out national health
  surveillance activities, and had identified
  concerns
• Process not well integrated
• Business processes require further definition
• Inconsistent analysis, trending and forecasting
  processes
• Inconsistent data quality
• incomplete, or not specific enough, untimely
• Inconsistent surveillance standards
• Results Need to improve current system

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In the beginning CIPHS

• Health Canadas response
• build a pan-Canadian health surveillance network
  where useful, timely information can be securely
  shared
• CIPHS Program created
• to identify solutions for managing public health
  events
• build an integrated suite of computer and
  database information systems specifically for use
  by front-line public health professionals
• Funded to build a solution
• Result PHIS adopted by CIPHS as a solution in
  2000
• Web based iPHIS development initiated

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In the beginning BC

• Immunization registry pilot successful in Vernon
• Strategic plan for Public Health established and
  funded
• Result 1992 - PHIS Project started in BC with 2
  pilot sites
• CRD Health (Victoria)
• Simon Fraser Health Unit
• 1995 - PHIS formal evaluation
• Result Significant benefit and should be
  implemented provincially
• Infrastructure cost prohibitive

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In the beginning BC (cont)

• 1998 - Regionalization Implemented in BC
• ResultsTransition of IP to BCCDC
• Infrastructure issue diminished
• BCCDC initiates provincial roll out program in
  joint venture with Regions
• 2000 - Roll out completed
• Result 100 CD provincial reporting through PHIS
• Health Canada adopts PHIS program (6m)
• IP rights transfer to Health Canada

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CHAPTER 2

• The Evolution

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PHIS Classic

• Focused on the public healths encounter with a
  client
• Critical Mass of functionality
• Client Server based
• Very difficult to upgrade each PC in the
  province had to be updated on the same day
• No sharing between Regions
• Duplicate data issues
• Implemented wed based Ad hoc reporting tools
• Linked to Provincial Client Registry
• First application of lab test standards for test
  results

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iPHIS

• BC Build of iPHIS started in 2002
• Based on Pan-Canadian input
• Began implementation in 2003 in BC
• Ability to have data sharing on or off per
  jurisdiction
• Enhances jurisdictions/Health Canadas ability
  to anticipate, control, prevent risks to the
  publics health
• Links to Provincial Client Registry
• BCs lab test standard used for TB requisitions
  results
• Considered Public Healths Charting tool or EHR

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CHAPTER 3

• What it does.

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Demographics

• Stores client information
• Contact info for client
• Relations Aliases of client
• Notes/Alerts regarding client
• In Synch with Client Registry
• Family Relationships

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Scheduling/Wait Queue/Referrals

• Online Schedules allow for time day closures
• Facilitates nursing physician clinic work flow
  using wait queues
• Doctor selects client from wait queue and can
  review client file from there
• Referals allow electronic questions, follow ups,
  queries to be sent across province with attached
  client charting

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Communicable Disease (CD)

• Allows cases to be created on a per client basis,
  or linked as an Outbreak
• Includes Rabies component
• Provinces CD case management
• Case definitions
• Signs Symptoms

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TB control

• Provides for reporting to full clinical operation
• Allow for Rx and med order/refill mapping
• Links with Lab component
• Tracks Skin Test Radiology studies

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Sexually Transmitted Disease (STD)

• Allows multiple Encounter creation for clients
• Tracks Client Contacts, Diagnosis, Treatment
  History
• Links with Electronic Lab
• Tracks Antibiotics and IDU
• Unique security provisions

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Mass

• Primarily used in class list uploads for school
  based mass services
• Includes Immunization Audit component
• Calculates when clients are due
• imms based on National/Provincial schedules.
• Allows for real time client data quick entry
  during immunization, dental, vision and hearing
  clinics.

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Public Health Summary

• Supports clients Immunization, Dental, Vision
  Hearing history appointments
• Addresses range of public health services
• Post Partum Assessment
• Early Childhood Assessment
• Education Counseling
• Newborn Assessment
• Links to Lab to request requisitions, or track
  results

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CHAPTER 4

• The Pan-Canadian Perspective

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Whos using iPHIS?

• REGIONS
• Canada-wide
• BC
• Yukon
• NWT
• Alberta Health Wellness
• David Thompson Health Region (Alta)
• Saskatchewan
• Manitoba (Winnipeg Health Region)
• Ontario
• Newfoundland (Pilot)
• Bahamas

• HEALTH CARE PROVIDERS
• Provinces
• Health Regions/Authorities
• Health Units
• Doctors
• Nurses
• Clerks
• Radiologists
• Lab Technicians
• Psychiatrists/Counselors
• Specialists
• TB Control
• STD

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Governance

• CIPHS established collaborative committee
• All Provinces/Territories Represented
• Product Management
• Functionality
• Support
• Communications
• Established Cost/Benefit model for P/Ts
• Plans for Sustainability
• Mentored
• iPHIS
• LDMS, etc.

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Growth

• Planned funded development
• Established focus/user groups
• Implemented change management process
• Managed Modular Growth

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Ontario Builds Outbreak Module

• SARS in Ontario
• iPHIS used during outbreak
• Naylor Report
• Quarantine Management
• Case Counting, etc.
• Funded Outbreak Module
• Legislated funded iPHIS implementation

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The Outbreak Module (cont)

• Allows for tracking an outbreak on the larger
  scale, as well as the per client scale
• Built in collaboration with front line outbreak
  health specialists
• Collects Details as to Contacts, Cases, Exposures
  and Supply Orders
• Functionality allows for merging of Outbreak
  records, once two outbreaks have been deemed to
  be infact the same

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BC Builds Primary Assessment Care Module

• BC Corrections required health services
  application
• Foresaw link with regional public health
• Coroners inquest recommended needs for single
  EHR
• Search Resulted in recommendation to build on
  iPHIS
• Build nearing completion

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The PAC Module

• Focuses on Charting patients history and
  physician/nursing notes
• Developed in collaboration with health
  professionals working onsite at correctional
  institutions
• Workflow follows SOAP principle Subjective,
  Objective, Assessment, Plan
• Optional integration with clients public health
  data

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CHAPTER 5

• The Good, the Bad the Ugly

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The Good

• Funding (?)
• Focused on field needs
• Works in 10 different sites
• Significant improvement in data quality

• Reduction in CD reporting times
• Enhanced surveillance reports
• Pooled Support
• Web Based
• S/W Maintenance easier
• IM/IT Resource requirement minimal

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The Bad

• Project Sponsors sometimes Cloudy
• Not treated as a product

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The Ugly.

• Variable Budgets
• User Groups (Close but no cigar)
• Focus on tools as opposed to needs

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CHAPTER 6

• The Never Ending iPHIS Story

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Never Ending iPHIS Story

• PHAC continues to support and develop iPHIS
• Infoway receives 100M for surveillance
• High level requirements defined
• Product Strategy developed
• Use iPHIS navigation standards
• Use COTS when possible

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Never Ending iPHIS Story

• Scope deferences
• Plan surveillance product implementation Summer
  06
• Sustainability plan being developed by PHAC

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EPILOGUE

• Question Answer