E-Health and the future

1. E-Health and the twenty-first century trends

2. Contact Details Cell Phone: 250-507-4343 Victoria , BC Canada [email_address] 15 years healthcare specialist experience and practice management consulting. Utilizing extensive industry experience within medical equipments, IT healthcare (PACS/RIS/CIS & CVIS), pharma, biotech, clinical research and healthcare to execute and implement certain process as well as methodology into diverse operational roles at all organizational levels.

8. I am a human being. I seek to enhance my quality of life. I am 53 years old and recently woke up with pain in my chest. My father died of a heart attack at 44 and my mother is living with diabetes. I have never smoked. I walk my dog in the park every day and try to watch my diet. I am 5' 9" tall and weigh 142 pounds. I know I must monitor my blood sugar. I am allergic to sulfa drugs and take two aspirin every day. I eat two eggs for breakfast daily. I have daughters and a grand daughter who are all healthy. My gallbladder was removed four years ago. I have green eyes. I have never had a stress test. I wish my doctor remembered our last visit, my hairdresser does. Enable my care team to provide the highest quality of care.

9. I am a doctor. I have more of everything these days, except time. More patients to see. More charts to complete. More data to interpret. I treated 70 patients today, followed up on 28 radiology reports and 44 lab reports, and wrote hundreds of orders. I must remember dozens of medications, protocols, dosages and guidelines. I have 6 months of medical journals sitting on my nightstand. I want to educate my patients, practice evidence-based medicine, offer preventative service and deliver good outcomes. I am a physician committed to my patients. Enable me to provide the best quality of care .

10. I am a nurse. I am devoted to the care of others. I have over 12 years of experience serving my patients and their care team. I coordinate the care of multiple patients, all at different stages of ill health. My pockets, stuffed full of reminders, work orders and pending tests are my only safeguard against missing charts and files. How am I supposed to document for the next care team? Room 207 got sick with her last dose of morphine, 209 needs teaching on her inhaler, I have vitals to check on everyone. I am a nurse who trained to work with people, not paper. Enable me to provide the best quality of care for my patients .

11. I am a CIO. I keep information flowing. I am responsible for a growing community health network with over 100 computing environments and 30 different vendors across 17 departments at 6 sites. I need stable systems, easy maintenance, no downtime, fast performance, implementation expertise and deep clinical functionality. I dream of a true partner who offers this in every department, helps me justify my IT investment and delivers on time and within budget. I seek to improve clinical outcomes, patient safety and productivity. With a true partner I can recruit the best talent, streamline information flow and employ the best technology. Help me make IT happen .

12. The Circle of Care Community Care Center From the EHRS Blueprint © Canada Health Infoway 2003-2005 Pharmacy Laboratory Diagnostic Hospital Emergency Homecare Clinic Emergency Services Specialist Clinic

13. The Patient Centric & Integrated View of Consolidated Information Pharmacy Laboratory Diagnostic Hospital Emergency Homecare Community Care Center Clinic Emergency Services Specialist Clinic From the EHRS Blueprint © Canada Health Infoway 2003-2005 QUALITY SAFETY ACCESSIBILITY Clients/Patients INTEGRATED VIEW Pharmacy Laboratory Diagnostic Hospital Emergency Homecare Clinic Emergency Services Specialist Clinic

15. The 10 e's in "e-health" 1-Efficiency - one of the promises of e-health is to increase efficiency in health care, thereby decreasing costs. One possible way of decreasing costs would be by avoiding duplicative or unnecessary diagnostic or therapeutic interventions, through enhanced communication possibilities between health care establishments, and through patient involvement. 2-Enhancing quality of care - increasing efficiency involves not only reducing costs, but at the same time improving quality. E-health may enhance the quality of health care for example by allowing comparisons between different providers, involving consumers as additional power for quality assurance, and directing patient streams to the best quality providers. 3-Evidence based - e-health interventions should be evidence-based in a sense that their effectiveness and efficiency should not be assumed but proven by rigorous scientific evaluation. Much work still has to be done in this area.

16. The 10 e's in "e-health" 4-Empowerment of consumers and patients - by making the knowledge bases of medicine and personal electronic records accessible to consumers over the Internet, e-health opens new avenues for patient-centered medicine, and enables evidence-based patient choice. 5-Encouragement of a new relationship between the patient and health professional, towards a true partnership, where decisions are made in a shared manner. 6-Education of physicians through online sources (continuing medical education) and consumers (health education, tailored preventive information for consumers) 7-Enabling information exchange and communication in a standardized way between health care establishments. 8-Extending the scope of health care beyond its conventional boundaries. This is meant in both a geographical sense as well as in a conceptual sense. e-health enables consumers to easily obtain health services online from global providers. These services can range from simple advice to more complex interventions or products such a pharmaceuticals.

17. The 10 e's in "e-health" 9-Ethics - e-health involves new forms of patient-physician interaction and poses new challenges and threats to ethical issues such as online professional practice, informed consent, privacy and equity issues. 10-Equity - to make health care more equitable is one of the promises of e-health, but at the same time there is a considerable threat that e-health may deepen the gap between the "haves" and "have-nots". People, who do not have the money, skills, and access to computers and networks, cannot use computers effectively. As a result, these patient populations (which would actually benefit the most from health information) are those who are the least likely to benefit from advances in information technology, unless political measures ensure equitable access for all. The digital divide currently runs between rural vs. urban populations, rich vs. poor, young vs. old, male vs. female people, and between neglected/rare vs. common diseases.

24. How to start

25. Checking and updating patient notes technology enabled Rapid patient updates or consultation Collaborating on patient diagnosis and care Test results sent instantly to multi-devices Online patient services and communications Patient discharge - wheelchair requested & room cleaned

28. What are the constraints? How do we get there? Where are we? Where do we want to be? How do we get started? What are the impacts? Strategic Planning Framework

29. Healthcare Projects Patients Registration Health Status Care Delivery Admission Area/ Location (Process) Access (Policy) Provider (Staff) Service Treatment Quality & Safety Productivity Technology

37. Canada Health Infoway CANADA HEALTH INFOWAY INC. INVESTS WITH PUBLIC SECTOR PARTNERS ACROSS CANADA TO IMPLEMENT AND REUSE COMPATIBL E HEALTH INFORMATION SYSTEMS THAT SUPPO RT A SAFER , MORE EFFICIENT HEALTH CARE SYSTEM . INFOWAY IS AN INDEPENDENT, NOT- FOR – PROFIT ORGANIZATION WHOSE MEMBERSARE CANADA’ S 14 FEDERAL , PROVINCIAL AND TERRITORIAL DEPUTY MINISTERS OF HEALTH .

39. EHRS BLUEPRINT The Electronic Health Record Solution (EHRS) Blueprint is a technology framework that enables the appropriate sharing of clinically relevant patient health information between health services providers across care settings and disciplines in Canada. The Blueprint provides a vision and direction for how information technology will be employed to allow the many different information systems used in health care to interoperate: allowing a health service provider to access information captured by other healthcare providers for the same patient/client.

40. HOW IT WORKS The Blueprint is an enterprise systems architecture that uses the well accepted principles of a Services Oriented Architecture to enable the applications at the many points of service to use one standards-based set of interfaces to exchange information through a shared EHR Infostructure (EHRi). Each jurisdiction in Canada will operate one or more instances of this standardized infostructure. The Blueprint describes how each point of service application can connect to the shared infostructure using a common set of interface standards, rather than connecting to each other directly. These interfaces are handled by the Health Information Access Layer (HIAL) which provides common services to support, for example, authorization and authentication of users and logging and auditing of all accesses. Point of service applications send distinct information about clients/patients to a set of shared information repositories that are managed by the Longitudinal Record Services. The applications (or an integrated viewer) can then request EHR information from the Infostructure using the same mechanisms, securely accessing relevant EHR information captured by many different health disciplines, in many different care settings, and potentially in many jurisdictions across Canada. Each infostructure can communicate with other infostructures, collaborating to deliver clinically relevant information where and when it is needed, regardless of where it was originally captured .

41. The building blocks include individual electronic health records (EHR), health information management systems in large and small healthcare settings called Point of Service applications (PoS), health information repositories and warehouses, and special service applications that screen and manage health information as it is transmitted from one point to another. These capabilities, combined with a supporting infostructure that connects them all, is called the EHRS.

42. The EHR Infostructure is made up of: • Registry systems to manage and provide the information required to uniquely identify the actors and resources in the EHR. These identified elements include the name of the patient/client (including a unique identifier), the provider of care, the location of care, the end users of applications and the terminologies used to describe diseases, acts or other clinically relevant information. Registries which hold patient/client consent information are part of the EHRi as well. Figure 1 The EHR Solution Concept Source: Canada Info Way

43. Figure 2 EHR as Network of HER infostructures Source: Canada Info Way

44. Figure 3 PoS Systems Source: Canada Info Way

45. Figure 4 EHRi Data Repositories Source: Canada Info Way

46. Source: Canada Info Way

47. Figure 6 Registry Services Source: Canada Info Way

48. Figure 7 Longitudinal Record Services Source: Canada Info Way

49. Figure 8 The Health Information Access Layer (HIAL) Source: Canada Info Way

50. Figure 9 EHR Viewer Source: Canada Info Way

51. Figure 10 Communications Services in the HIAL Source: Canada Info Way

52. Figure 11 HIAL Common Services Source: Canada Info Way

57. Snapshot of the Vendor Market Share Source: Information and Communications Technology Council Report 2008

58. Snapshot of the Vendor Market Share Source: Information and Communications Technology Council Report 2008

59. Snapshot of the Vendor Market Share Source: Information and Communications Technology Council Report 2008

60. Snapshot of the Vendor Market Share Source: Information and Communications Technology Council Report 2008

61. Snapshot of the Vendor Market Share Source: Information and Communications Technology Council Report 2008

62. Snapshot of the Vendor Market Share Source: Information and Communications Technology Council Report 2008

63. Snapshot of the Vendor Market Share Source: Information and Communications Technology Council Report 2008

64. Snapshot of the Vendor Market Share Source: Information and Communications Technology Council Report 2008

65. Snapshot of the Vendor Market Share Source: Information and Communications Technology Council Report 2008

66. Is It worth to invest and start ?

67. It’s not just what you connect Equipment Public Health Organizations Laboratories Pharmacies Clinicians Clinics Emergency Responders S uppliers Payers After Care Imaging O.R.s & Beds

68. Or how you connect it

69. It’s planning holistically Infrastructure Information Finance & Utilities Mobility & Security Supply Chain People & Processes

70. It’s planning holistically for maximum design efficiency Infrastructure Information Finance & Utilities Mobility & Security Supply Chain People & Processes

72. Healthcare & Project Management = Plan the work , then work the plan

73. Patient Management Technology Best Quality of Care 01

74. We want a system or a solution that enables us to provide the best quality of care to our patients and assist us in making decisions. We want a system or a solution modeled on how we work that provides access to comprehensive, real-time information from anywhere. We want a system or a solution that will help us reduce our costs and be easy to maintain and update. 02

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77. P L A N N I N G F U N D I N G Step 0 Deafine Expected / Targeted Mission Statement M A N A G E M E N T O V E R S I G H T Time Step 1 Concept Definition Step 2 Concept Development Develop Process Time Step 3 System Definition Prototype and System Design Time Step 4 Process/ System Life Cycle Development and Testing Step 5 Production and Deployment Project Plan (P0, P1, P2 & P3) P 0 Issue : Planning Guidance Milestone 0 Project Initiation Approval P 1 Final Approves Project Funding 0 Fund Project Milestone 1 Prototype Development Approval P 2 Execution Funding 1 Fund 1 Status Review Funding 2 Fund 2 P 3 Closure Milestone 2 System Development Approval Funding 3 Fund 3 System Testing

78. Thank you for your attention! Any Questions?