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  • It is a pleasure to be here and speaking to you today. Thanks also to the BC Government’s CIO office and the conference sponsors for making this session possible Louise and I will speak to you today about how BC Health, through the eHealth BC program, is moving toward the electronic health record and electronic service delivery. However, in today’s presentation you will not hear how we are enabling health service delivery directly to BC Citizens. That is not to say that electronic access by citizens to their health information is not important. It most certainly is. But, we must take stepping stones toward enabling this access. As we all know, health service delivery is primarily interpersonal. You visit your doctor, you walk in to a clinic or emergency department, you visit a public health office or a lab. We are not at the point (and should we ever be?) where you consult a GP computer who then refers you to another specialist computer. Therefore, a first priority is enabling providers at the point of care by improving the availability of integrated, comprehensive and accurate health information. What does enabling providers require? It requires an integrated, person centric view of health information. This is the electronic health record. In today’s world, health information is typically retained in islands: in the doctor’s office, in acute hospital information systems, in the pharmacy. We are all familiar with repeated questions about our demographics, our medical history, our family history. These questions are a direct outcome of the fragmented world of health information There is heavy reliance on the individual to provide integration. We must integrate these information islands. And make this integrated view available to providers in a way that meets individual’s needs for security and privacy. Another significant pressure driving health toward electronic services is the need for efficiency: There are too many redundant or duplicate tests, there is too much paper, we make sub optimal decisions, we do not have the information to conduct all the strategic analysis we would like BC Health now consumes approximately 40% of the provincial budget. When I started in the health business, this was figure was 25%. We must find ways to manage the cost of health. Much of the focus in the last two decades has been on improving the efficiency of health administration. We must now shift to improving clinical efficiency This presentation outlines the approach being taken by BC Health to address these challenges
  • Ehealth

    1. 1. eHealth BC Enabling electronic services for BC Health
    2. 2. Overview <ul><li>Background </li></ul><ul><li>BC eHealth </li></ul><ul><li>Service Oriented Architecture in eHealth </li></ul><ul><li>Summary </li></ul>
    3. 3. Background
    4. 4. Historical Context <ul><li>Early 1990’s - Client Registry </li></ul><ul><ul><li>Personal Health Number (PHN) for individuals in the BC Health system </li></ul></ul><ul><li>1994 - HealthNet/BC and BC Government’s SPAN/BC </li></ul><ul><ul><li>Secure communications and messaging infrastructure </li></ul></ul><ul><li>1996 - PharmaNet </li></ul><ul><ul><li>First provincial application with some clinical support </li></ul></ul><ul><li>2003 - Provider Registry (2003) </li></ul><ul><ul><li>Doctors, nurses, pharmacists </li></ul></ul><ul><li>2006 - Client Registry 2 </li></ul><ul><ul><li>client identity management </li></ul></ul>
    5. 5. Historical Context (cont’d) <ul><li>Federal Canada Health Infoway (CHI) </li></ul><ul><ul><li>1999 – formation recommended by the Advisory Council on Health Infostructure </li></ul></ul><ul><ul><li>2001 – launched </li></ul></ul><ul><ul><ul><li>A high-quality, sustainable and effective Canadian healthcare system supported by an infostructure that provides residents of Canada and their healthcare providers with timely, appropriate and secure access to the right information when and where they enter into the healthcare system. Respect for privacy is fundamental to this vision. </li></ul></ul></ul><ul><ul><li>CHI provides </li></ul></ul><ul><ul><ul><li>National vision and consensus building </li></ul></ul></ul><ul><ul><ul><li>Standards and Architecture </li></ul></ul></ul><ul><ul><ul><li>Strategic investment </li></ul></ul></ul>
    6. 6. Historical Context (cont’d) <ul><li>Provincially </li></ul><ul><ul><li>2002 – the Premier’s Technology Council recommends the provincial government implement a common electronic health record. </li></ul></ul><ul><ul><li>Ongoing and increasing pressure to increase the efficiency of the health system </li></ul></ul>
    7. 7. BC eHealth
    8. 8. BC eHealth <ul><li>Is a response to the business opportunities and pressures </li></ul><ul><li>Guides, leads and organizes electronic health activities across the BC health sector </li></ul><ul><li>Collaboration is a key success factor </li></ul><ul><li>eHealth evolution </li></ul><ul><ul><li>Conceptual System Architecture </li></ul></ul><ul><ul><li>Strategic Framework </li></ul></ul><ul><ul><li>Program </li></ul></ul>
    9. 9. eHealth Strategic Framework <ul><li>Vision and Strategy for eHealth in British Columbia </li></ul><ul><ul><li>Authored by the eHealth Steering Committee </li></ul></ul><ul><ul><li>Outlines health system challenges, needs and expected benefits of electronic health </li></ul></ul><ul><ul><li>Identifies strategic eHealth initiatives, lead agency and timelines </li></ul></ul><ul><ul><li>Recommends governance and project management strategies </li></ul></ul><ul><li>Strong executive support </li></ul><ul><li> </li></ul>
    10. 10. eHealth Strategic Framework (cont’d) <ul><li>Stakeholders </li></ul><ul><ul><li>Health care providers </li></ul></ul><ul><ul><li>Health authorities </li></ul></ul><ul><ul><li>Private health service organizations </li></ul></ul><ul><ul><ul><li>Retail pharmacies </li></ul></ul></ul><ul><ul><ul><li>Private laboratories and other diagnostic clinics </li></ul></ul></ul><ul><ul><li>Ministry of Health </li></ul></ul><ul><ul><li>BC residents </li></ul></ul><ul><ul><li>Canada Health Infoway (CHI) </li></ul></ul><ul><ul><li>Office of the Privacy Commissioner </li></ul></ul><ul><ul><li>Colleges and professional associations </li></ul></ul><ul><li>And many more… </li></ul><ul><li>You need to know </li></ul><ul><ul><li>Who your stakeholders are </li></ul></ul><ul><ul><li>How to engage them </li></ul></ul>
    11. 11. eHealth Strategic Framework (cont’d) <ul><li>Pillars: </li></ul><ul><li>Primary / Physician Care </li></ul><ul><li>Acute / Hospital Care </li></ul><ul><li>Home and Community Care </li></ul><ul><li>Population and Public Health </li></ul><ul><li>Laboratory </li></ul><ul><li>Pharmacy – eDrug </li></ul><ul><li>Diagnostic Imaging </li></ul><ul><li>Telehealth </li></ul>Foundational Components e.g. Physician Connectivity, Authentication, Client Identity Management, System Security, EHR Index, Provider Registry, eHealth Viewer and Integration Service s Acute / Hospital Care Home and Community Care Population and Public Health Laboratory Pharmacy - eDrug Diagnostic Imaging Telehealth Primary / Physician Care Overarching Benefits <ul><li>Improved quality, safety and outcomes </li></ul><ul><li>Increased efficiency, productivity, and cost effectiveness </li></ul><ul><li>Enhanced service and satisfaction for citizens, patients, and providers </li></ul>
    12. 12. eHealth Conceptual Architecture <ul><li>Purpose </li></ul><ul><ul><li>Refine and confirm the BC EHR architecture </li></ul></ul><ul><ul><li>Build consensus with senior management and technical staff </li></ul></ul><ul><li>Aligned with the Infoway blueprint </li></ul><ul><ul><li>Message based service oriented architecture </li></ul></ul><ul><ul><li>Standards based </li></ul></ul>
    13. 13. eHealth Program <ul><li>Realize the vision of electronically integrated health care in British Columbia </li></ul><ul><ul><li>Manage the initial slate of eHealth projects </li></ul></ul><ul><ul><li>Directed by the Ministry </li></ul></ul><ul><ul><li>Health Authority or Ministry leads on individual projects </li></ul></ul><ul><li>Includes the following major projects </li></ul><ul><ul><li>iEHR infrastructure, EHR Viewer and Secure Health Record </li></ul></ul><ul><ul><li>Lab </li></ul></ul><ul><ul><li>Drug </li></ul></ul><ul><ul><li>Diagnostic Imaging (DI) </li></ul></ul><ul><ul><li>Public Health Surveillance </li></ul></ul><ul><ul><li>Physician office electronic medical record (EMR) </li></ul></ul>
    14. 14. Service Oriented Architecture
    15. 15. Service Oriented Architecture (SOA) <ul><li>A style of information systems architecture </li></ul><ul><ul><li>Creating applications by combining loosely coupled and interoperable services </li></ul></ul><ul><li>A service is a function that is </li></ul><ul><ul><li>Well-defined </li></ul></ul><ul><ul><li>Self-contained </li></ul></ul><ul><ul><li>Does not depend on the context or state of other services </li></ul></ul><ul><li>Services inter-operate based on a formal definition (or contract) which is independent of the underlying platform and programming language . </li></ul>
    16. 16. Infoway Service Oriented Blueprint
    17. 17. SOA Within an Organization <ul><li>Common services </li></ul><ul><ul><li>Privacy and security </li></ul></ul><ul><ul><li>Identity management </li></ul></ul><ul><ul><ul><li>Client, provider, user, system/application </li></ul></ul></ul><ul><li>Inter-application communication </li></ul><ul><ul><li>Requires standards </li></ul></ul><ul><ul><ul><li>Business process </li></ul></ul></ul><ul><ul><ul><li>Technical interoperability </li></ul></ul></ul><ul><ul><ul><li>Data definition </li></ul></ul></ul><ul><ul><ul><li>Security </li></ul></ul></ul>
    18. 18. SOA Between Organizations Management Technical Governance & Policy Services Management Privacy Security Compliance Verification Standards Definition
    19. 19. SOA Between Organizations – Management <ul><li>Governance & Policy </li></ul><ul><ul><li>Governance structure & processes </li></ul></ul><ul><ul><li>Policy definition and processes </li></ul></ul><ul><ul><li>Information sharing agreements </li></ul></ul><ul><li>Privacy policy </li></ul><ul><li>Service Management </li></ul><ul><ul><li>Service delivery </li></ul></ul><ul><ul><ul><li>Operations monitoring </li></ul></ul></ul><ul><ul><ul><li>Help desk </li></ul></ul></ul><ul><ul><li>Service maintenance & enhancement </li></ul></ul><ul><ul><ul><li>Change management </li></ul></ul></ul><ul><ul><li>Security </li></ul></ul><ul><ul><ul><li>Security processes & audit </li></ul></ul></ul>
    20. 20. SOA between Organizations – Technical <ul><li>Standards definition </li></ul><ul><ul><li>National (Infoway sponsored) </li></ul></ul><ul><ul><ul><li>HL7v3 Reference Information Models : structure and content </li></ul></ul></ul><ul><ul><li>Provincial </li></ul></ul><ul><ul><li>Ministry </li></ul></ul><ul><li>Compliance verification </li></ul><ul><ul><li>Technical, business, security </li></ul></ul><ul><li>Security </li></ul><ul><ul><li>Security framework </li></ul></ul><ul><ul><li>Identity management </li></ul></ul>
    21. 21. Summary – Success Factors <ul><li>Business </li></ul><ul><ul><li>Driving business needs </li></ul></ul><ul><ul><li>Organizational commitment and leadership </li></ul></ul><ul><ul><li>Collaboration, stakeholder engagement </li></ul></ul><ul><ul><li>Funding </li></ul></ul><ul><li>Technical </li></ul><ul><ul><li>Interoperability standards </li></ul></ul><ul><ul><li>Architecture </li></ul></ul>