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The Canada Health Infoway Plan.


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Richard C. Alvarez. President & CEO Canada Health Infoway.

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The Canada Health Infoway Plan.

  1. 1. The Canada Health Infoway Plan1 Presentation by Richard Alvarez | President and CEO, Canada Health Infoway | February 22, 2008
  2. 2. Overview • The Canadian context • The need for EHR in Canada • Infoway’s mission, approach, programs • Progress across Canada • Value to stakeholders • Challenges and opportunities2
  3. 3. The Canadian context3
  4. 4. Canada is a large Geographic size country Second largest country in the world – 10M km2 6 time zones 7% of world’s renewable fresh water supply Governance Federal, 10 provincial and 3 territorial governments British Parliamentary system A Commonwealth nation4
  5. 5. Canada has a small Population Size and Location population 32.6 million people - 3.3/km2 - among the lowest population densities in world 76% urban; 24% rural Most live within 400km of the US border Ethnically Diverse British Isles: 28% French: 23% Other European:15% Non-European: 6% Mixed heritage: 25% Aboriginal: 3%5
  6. 6. Canada is Internet Usage connected 68% of Canadians use the internet (2005) • 91% for e-mail • 65% weather, travel • 62% news, sports • 55% banking, pay bills Broadband Availability Greatest broadband penetration in G7 76% of households using the internet in Canada have high speed connectivity and 24% use low speed dial-up options (2005)6
  7. 7. Health care is Cost universally $148 billion business available 10.4% of GDP 65% of costs for hospitals, physicians and drugs Financing 70% public funding 30% private funding, primarily for drugs, dental and co-pay services Most privately provided health care services (e.g. physicians, laboratories, diagnostic imaging) are publicly funded7
  8. 8. Governance Governance through shared Federal government sets and administers national principles accountability 13 provincial/territorial governments plan, finance, manage, evaluate health services 100+ health regions coordinate care delivery over a set geographical area 900+ hospitals manage care Approximately 400,000 health care professionals deliver care8
  9. 9. Health care drivers Pressure on the health system Canadas population is aging fast By 2011, an estimated 1.3 million Canadians will be over the age of 80 Senior citizens will outnumber children in about a decade Health of baby boomers is declining Health care spending is increasing Wait times are a major issue Political debates over private sector role in health care delivery9
  10. 10. Managing patient care in this complexity10
  11. 11. Great expectations What Canadians expect from their health care system: • Accurate information that moves with them • Communication between their various health care providers • Protection of their privacy • Input into decisions • Elimination of undue risk • Timely access/results11
  12. 12. The need for EHR For every… …in Canada 1,000 hospital admissions 75 people will suffer an adverse drug event 1,000 patients with an ambulatory encounter 20 people will suffer a serious drug event 1,000 patients discharged from hospital 90 people will suffer a serious adverse drug event 1,000 laboratory tests performed up to 150 will be unnecessary (range 50-150) 1,000 emergency department visits 320 patients have an information gap identified, resulting in an average increased stay of 1.2 hours 1,000 Canadians recommended for influenza protection 370-430 are not vaccinated12
  13. 13. The need for health information management Providers, managers, Consumerism is patients, public are Population is aging growing demanding more Pressures on IT has potential to Care settings are resources are greater enable solutions to shifting address pressures13
  14. 14. Annual IT spending Canada’s health care system is so huge it would rank No. 10 Percentage of total budgets/revenues on the Fortune 500. It is more than three times the size of 5.4 the country’s largest bank (compared to total revenue). Yet Canada under-invests in 4.7 4.5 health care IT relative to other health care providers and 4.0 information management industries. 3.4 2.9 1.5 – 2.0 Education US HC UK Calgary Professional US banking/ HC IT spend providers health care Regional services financial Canadian Health services jurisdictions Authority14
  15. 15. Benefits of EHRs Quality Quality Productivity Productivity •• Better continuity of care improves disease and Better continuity of care improves disease and •• Provides time savings Provides time savings case management case management •• Avoids unnecessary diagnostics, procedures and visits Avoids unnecessary diagnostics, procedures and visits •• Appropriate care adheres to standards Appropriate care adheres to standards •• Optimizes coordination of human resources Optimizes coordination of human resources •• Prevention of adverse events and public health threats Prevention of adverse events and public health threats Improving quality improves health, Improving the productivity of health reduces the burden on the system, care saves costs and makes optimal and ensures optimal use of available human and other use of capacity. 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 Reduced wait times Capital cost : $10 billion to $12 billion Benefits: $6 billion to $7 billion in savings annually15
  16. 16. What is an EHR? An electronic health record (EHR) is a secure and private lifetime record of an individual’s health and care history, available electronically to authorized health providers.16
  17. 17. Sample of an EHR Results and images Patient information Medical alerts Medication history Interactions Problem list Immunization17
  18. 18. What Canadians think about EHRs According to a recent, independent survey: • 88 per cent support electronic records • Canadians believe electronic health records will enable health care providers to deliver better quality care • Increase effectiveness for doctors 87 per cent • Increase effectiveness for pharmacists 86 per cent • Increase effectiveness for nurses, patients 81 per cent and the health care system in general * EKOS survey18
  19. 19. Infoway’s mission, approach, programs19
  20. 20. Canada Health Infoway • 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 Goal: By 2010, every province and territory and the populations they serve will benefit from new health information systems that will help modernize their health care system. Further, 50 per cent of Canadians will have their electronic health record readily available to their authorized professionals who provide their health care services.20
  21. 21. About Infoway Our 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 Canadians21
  22. 22. Infoway adopted a unique strategicinvestor role Strategic Governor Funder Intervener Developer investor Set direction Fund and Invest, advise, Work alongside Write code and standards ignore and monitor and takeover if and build needed modules Canada UK Denmark Norway Australia New Zealand Kaiser Canada has a unique strategic investor Veteran’s Affairs role that brings together a collaborative engagement model, a shared Primary role governance model, and a gated funding Secondary role approach22
  23. 23. Infoway business strategies • Targeted investment programs • Limited scope/goal • Collaborate with health ministries and other partners • Co-invest with public sector partners (75:25 formula) • Leverage investment • Form strategic alliances with the private sector • Manage risk and ensure quality solutions • Focus on end-user acceptance • Measure benefits and adjust23
  24. 24. Infoway programs Ten investment programs totalling $1.636 billion End-user Adoption and Setting the Innovation and Adoption – $60 -million Innovation and Adoption $60 million* Future Direction Health care Public Health Patient Access Cancer Chronic Diseases Telehealth Applications and Surveillance to Quality Care $100 million $135 million $50 million Primary Care Mental Health Innovation Projects The Electronic Interoperable EHR – $365 million Health Record Laboratory Diagnostic Registries and Registries Drug Systems Systems Imaging Domain Repositories $134 million $250 million $170 million $340 million Architecture Infostructure – $32 million and Standards24
  25. 25. Focus on standards and interoperability • Common architecture largely accepted by jurisdictions • Revised architecture includes privacy and security • Comprehensive standards collaboration process • New Infoway Standards Collaborative25
  26. 26. The EHR architecture JURISDICTIONAL INFOSTRUCTURE Registries Data Ancillary Data EHR Data Data & Services & Services & Services Warehouse Client Registry Immunization PHS Shared Drug Diagnostic Health Laboratory Management Reporting Health Record Information Imaging Information Provider Registry Location Registry Business EHR Message Normalization Terminology Rules Index Structures Rules Repository Longitudinal Record Services Security Mgmt Privacy Data Configuration Data Common Services HIAL Communication Bus Radiology Public Health Pharmacy Lab System Hospital, LTC, Physician Center EHR Services System (LIS) CCC, EPR Office EMR PACS/RIS Viewer Public Health Pharmacist Radiologist Lab Clinician Physician/ Physician/ Provider Provider Provider Physician/POINT OF SERVICE Provider26
  27. 27. Electronic health records: Linked jurisdiction networks Distributed, message-based, peer-to-peer network of EHRS systems EHRS EHRS EHRS EHRS EHRS EHRS EHRS27
  28. 28. Progress across Canada28
  29. 29. Summary of project activity 245 active and 245 active and completed projects with completed projects with an estimated value of an estimated value of $1.332 billion as at $1.332 billion as at Dec. 31, 2007 Dec. 31, 2007 11 Registries29 Diagnostic Imaging Drug Info Systems Lab Info Systems TelehealthInteroperable EHR Public Health Surveillance Innovation & Adoption Number of Projects
  30. 30. Planning 53 projects * Implementation March 2004 = $125.2 million Completed Projects * Includes 27 pan-Canadian projects not shown30
  31. 31. Planning Implementation 245 projects ** Completed Projects December 2007 = $1.332 billion ** Includes 93 pan-Canadian projects not shown31
  32. 32. Leveraging EHR for innovative health care Quebec MSSS British Columbia Ministry of Health Electronic patient evaluation and service Newfoundland & Labrador’s Eastern Health planning solutions Pilots for province-wide adverse events reporting, analysis and management Sherbourne Health Centre Remote electronic records for a Health Alberta Capital/Calgary Health Bus serving the inner city homeless Public Regions Health Patient Extend Albertas iEHR and chronic Sault Ste Marie Safety disease management solutions to Link primary care providers Primary primary care teams and pharmacists to the Health EMR/EHR Care Grand River Hospital EHR Chronic Patient portal will provide access to health information for cancer Vancouver Island Health Disease and renal patients Authority EHR-based clinical decision support tools to for Mental Health & Addictions Cancer Care Ontario Services Cancer Computerized order entry and clinical decision support to benefit cancer patients Wait Scarborough Hospital Electronic self-entry (by patients) of patient Times history in emergency department (ED) using touch-screen kiosks32
  33. 33. The value to stakeholders33
  34. 34. EHR: Overall benefits & value • Reduced wait-times for diagnostic imaging services • Improved availability of community based health services • Reduced patient travel time and cost to access services ACCESS • Increased patient participation in home care • Improved interpretation of diagnostic and laboratory results • Decreased adverse drug events • Decreased prescription errors QUALITY • Increased speed and accuracy in detecting infectious disease outbreaks • Increased access to integrated patient information • Reduced duplicate tests and prescriptions PRODUCTIVITY • Reduced physician prescription call-backs • Reduced patient and provider travel costs34
  35. 35. Benefits evaluation plan To assess impact of Infoway investments in EHR solutions on health care quality, productivity and access Impacts identified will be used to: • Demonstrate value • Advance further investments • Encourage end user adoption • Highlight necessary adjustments in investment35
  36. 36. Infoway benefit evaluation framework The framework articulates the link between the systems in which Infoway invests and the resulting benefits, providing a basis for measurement. NET BENEFITS System quality Quality •Patient safety Functionality Use •Appropriateness/ Performance Use Behavior/ effectiveness Security Pattern •Health outcomes Self Reported Use Intention to Use Information Access •Ability of patients/providers quality to access services Content •Patient and caregiver Availability User participation Satisfaction Competency Service User Satisfaction Productivity Ease of Use •Efficiency quality Responsiveness •Care coordination •Net cost Based on the Delone & McLean IS Success Model36
  37. 37. Good news for the Canadian economy Investment in EHR is not a drain on government treasuries • Direct and indirect investments • Tax revenue • Domestic industry development • According to one recent study, EHR activity will create 37,000 jobs by 2010 or the equivalent of $2 billion in new labour income for Canadians37
  38. 38. Value to jurisdictions/ Value to patients governments • Cost avoidance • Diagnostic imaging • Quality • Drug information systems • Access • Chronic care • Sustainability • Elimination of undue risk • Health reform success38
  39. 39. Value to health care professionals Improve clinical decision-making • Deliver information at the right place at the right time • Promote prevention, screening and better disease management • Help manage knowledge complexity and promote evidence-based medicine • Provide enhanced diagnostic capabilities through digital imaging Enhance efficiency • Use appointment and scheduling systems to enhance workflow • Improve nurses’ efficiency with clinical documentation • Reduce need for filing, transcribing, phone calls photocopies Facilitate communication • Show electronic records and digital images to patients to facilitate understanding • Communication across the care team and the continuum of care39
  40. 40. Implications for physicians Infoway does not: • Purchase hardware/software for physician offices • Offer consulting services to help acquire or implement office systems But, Infoway does assist physicians by: • Developing standards for IT (the architecture) • Coordinating investment in the primary IT building blocks • Collaborating on privacy/security issues • Advancing an end-user acceptance strategy » Encouraging jurisdictions to invest » Working with physician organizations » Physician advisory group » Facilitating development of peer support networks40
  41. 41. Facilitating change through clinician e-Health support networks [CeHSN] Establish strong, supported networks of EHR/EMR/EPR peer leaders distributed across Canada to accelerate use of electronic health record solutions through peer leader support Peer leaders include physicians, nurses and pharmacists41
  42. 42. Objectives of CeHSN Support peers (physicians, pharmacists, nurses) in the use of technology within their practice settings and by integrating it into clinical work processes Identify common and unique barriers and exchange advice on the application of health care technology solutions Share best practices and build new knowledge Communicate stories that demonstrate accelerated uptake within/between regional networks and professional groups Collaborate with Infoway to enable an environment that accelerates the adoption and integration of information technology toward improving clinical care outcomes, access to information and improved productivity42
  43. 43. Lessons that are paying off • Joint governance • Common procurement • Joint planning • Common solutions • Predictable funding • National pricing • Common solutions • Shared services architecture • Knowledge sharing • Common ICT standards • Global leaders • Accountable spend 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.43
  44. 44. On the road to 201544 44
  45. 45. Priorities to 2015 Largest investment required 1 Foundational Elements Finish what started in electronic health records and public health surveillance 2 Implement electronic medical records in physician offices and physician order entry systems in hospitals 3 Enable public visibility for wait times and access Additional Elements 4 Facilitate patient self-care and empowerment 5 Trial and perfect more advanced functionality in wait times and chronic disease management45
  46. 46. Challenges and opportunities46
  47. 47. Challenges to overcome Physician office automation Clinician adoption Remote and first nations communities Jurisdictional capacity Standards Interoperability and vendors Patient engagement Further capitalization Public impatience“If you think that an electronic health record is an essential backbone ofany modern health care system, then [2015 is] far too long to wait.”Steven Lewis, Health Council of Canada, October 7, 200747
  48. 48. 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 • Reduced wait times48
  49. 49. Thank you!49