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Accelerating the Development and Implementation of Electronic Health Records in Canada Government Health and Technology Conference and Expo March 9 , 2006 Shelagh Maloney, Alliance Executive, Ontario Canada Health Infoway Agenda Context Benefits of an EHR Infoway’s Role Progress

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Slide1 l.jpg

Accelerating the Development and Implementation of Electronic Health Records in Canada

Government Health and Technology Conference and Expo

March 9, 2006

Shelagh Maloney, Alliance Executive, Ontario

Canada Health Infoway


Agenda l.jpg
Agenda Electronic Health Records in Canada

  • Context

  • Benefits of an EHR

  • Infoway’s Role

  • Progress

  • Approach

  • Challenges and Opportunities


Last year in canada l.jpg
Last Year, In Canada Electronic Health Records in Canada

  • 35 million Diagnostic Images

  • 440 million Laboratory Tests

  • 2.8 million Inpatient hospitalizations

  • 382 million Prescriptions filled

  • 3.4 million Vioxx Prescriptions in 2003 for patients that had to be contacted in 2004

  • 322 million office-based physicians visits - 94% resulting in handwritten paper records

  • 60,000 physicians faced 1.8 million new medical papers in 20,000 journals and 300,000 clinical trials

About 2,000 health care transactions per minute, many quite complex, and all requiring documentation and information flow

Information is the Lifeblood of our

Healthcare System!


Slide4 l.jpg
In spite of spectacular advances in medicine, the foundation of healthcare delivery is still primarily paper-based


Impact on quality of care lack of patient data affects access safety quality productivity l.jpg

1000 hospital admissions of healthcare delivery is still primarily

1000 patients discharged from hospital

1000 laboratory & radiology tests       

1000 women at risk of cervical cancer

1000 patient visits with a Specialist

1000 post-heart attack patients

75 people suffer an adverse event

90 suffer a serious problem with drugs received on discharge

Up to 150 are unnecessary duplicates

300-400 are not screened

680 Specialists received no patient info

370-460 don’t receive recommended Beta-blocker therapy

Impact on quality of care Lack of Patient Data affects access, safety & quality, productivity

  • For Every …. …. in Canada

In study of 168 traditional medical records 81% did not have the information required to make patient care decisions

CIHI estimates up to 24,000 deaths each year result from preventable adverse events in hospitals, in large part due to incomplete information


Electronic health records the international scene l.jpg
Electronic Health Records of healthcare delivery is still primarily The International Scene

  • Most industrialized countries have recognized the need to implement electronic health record solutions quickly to improve the quality and safety of patient care and system efficiency.

  • United States

  • United Kingdom

  • Australia

  • France

  • … and Canada


Calls for accelerated ehrs l.jpg
Calls for Accelerated EHRs of healthcare delivery is still primarily

  • The First Ministers continue to recognize the necessity of EHRs. In their “10-Year Plan to Strengthen Health Care”, they agreed-

  • “to accelerate the development and implementation of the electronic health record, including e-prescribing.”

  • Recommended a National Pharmaceuticals Strategy that would “broaden the practice of e-prescribing through accelerated deployment of the Electronic Health Record.”

  • Health Council of Canada’s first report, which recommended an “immediate broadening of the use of IT”, saying

    • “electronic patient records will pay huge health dividends in improved patient safety and lives saved.” “Canada can and should achieve this goal for all Canadians in five years – not fifteen.”


The benefits of an ehr l.jpg
The Benefits of an EHR of healthcare delivery is still primarily


Electronic health records access the benefits of electronic health records and infoway s priorities l.jpg
Electronic Health Records – Access of healthcare delivery is still primarily The Benefits of Electronic Health Records and Infoway’s Priorities

  • Infoway

  • Electronic Health

  • Record

  • Demographics

  • Diagnostic Images

  • Laboratory Results

  • Drug Profile

  • Clinical Reports

  • Immunizations

  • Telehealth

  • 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

  • Access

  • Availability of Services

  • Ability to Access Services

  • Patient Participation


Electronic health records quality l.jpg

  • Decreased medical errors of healthcare delivery is still primarily

  • Improved interpretation of diagnostic and laboratory results

  • Decreased adverse drug events

  • Decreased prescription errors

  • Improved prescribing practice

  • Increased speed and accuracy in detecting infectious disease outbreaks

Electronic Health Records - Quality

  • The Benefits of Electronic Health Records and Infoway’s Priorities

  • Infoway

  • Electronic Health

  • Record

  • Demographics

  • Diagnostic Images

  • Laboratory Results

  • Drug Profile

  • Clinical Reports

  • Immunizations

  • Telehealth

  • Quality

  • Safety

  • Effectiveness

  • Appropriateness


Electronic health records productivity l.jpg
Electronic Health Records - Productivity of healthcare delivery is still primarily

  • The Benefits of Electronic Health Records and Infoway’s Priorities

  • Infoway

  • Electronic Health

  • Record

  • Demographics

  • Diagnostic Images

  • Laboratory Results

  • Drug Profile

  • Clinical Reports

  • Immunizations

  • Telehealth

  • Increased access to integrated patient information

  • Reduced duplicate tests and prescriptions

  • Reduced physician prescription call-backs

  • Reduced patient and provider travel costs

  • Improved vaccine management

  • Improved information management resulting in reduced costs

  • Productivity

  • Efficiency

  • Care Coordination


Electronic health records the financial payoff l.jpg

  • Infoway of healthcare delivery is still primarily

  • Electronic Health

  • Record

  • Demographics

  • Diagnostic Images

  • Laboratory Results

  • Drug Profile

  • Clinical Reports

  • Immunizations

  • Telehealth

  • Decreased medical errors

  • Improved interpretation of diagnostic and laboratory results

  • Decreased adverse drug events

  • Decreased prescription errors

  • Improved prescribing practice

  • Increased speed and accuracy in detecting infectious disease outbreaks

Electronic Health RecordsThe Financial Payoff

Benefits = $30 million/ year1

Access

  • Medical Transportation Savings = $30 m/yr

Benefits = $3.4 billion/ year2

Quality

  • Inpatient ADE = $1.6 b/yr

  • Ambulatory ADE = $1.4 b/yr

  • Post Discharge ADE = $0.4 b/yr

Benefits = $1.6 billion/ year 2,3

Productivity

  • Diagnostic Imaging Efficiencies = $1.1 b/yr

  • Laboratory Test Efficiencies = $0.5 b/yr

  • Sources

  • Health Canada – Telehealth Evaluation

  • Booz Allen Hamilton – EHR ROI Model

  • Courtyard Group – DI ROI Model


Example drug information systems l.jpg
Example of healthcare delivery is still primarily Drug Information Systems

  • 7 active projects in 7 jurisdictions

  • AB: Province-wide DIS with e-prescribing, drug profile, adverse-reaction alerts

  • ON: To view Ontario’s Drug Program information, initially Emergency room access

  • SK: Province-wide DIS for 95% of meds prescribed – begins 2005

  • Developing clinical drug messaging standards. Drug claims message standards already developed

…. When VIOXX was pulled from the market, it took our practice just one hour to produce a report on patients who had been prescribed the medication, allowing us to contact every one of them the same day.”

Dr. Sue MacLean, Founding Partner,Markham Family Physicians

Expect $3.6 billion annual savings, Canada wide, avoiding adverse drug reactions and drug compliance issues


Infoway s role l.jpg
Infoway’s Role of healthcare delivery is still primarily


Canada health infoway l.jpg
Canada Health Infoway of healthcare delivery is still primarily

  • Infoway’s Role

  • 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. To build on existing initiatives and pursue collaborative relationships in pursuit of its mission.

  • Goal

    • Infoway’s plan is to have an interoperable electronic health record in place across 50 percent of Canada (by population)by the end of 2009.

Shared Governance Facilitates Collaboration

Canada Health Infoway is an independent not-for-profit organization, whose Members are Canada’s 14 federal, provincial and territorial deputy ministers of health.


Infoway s investment strategy l.jpg

“Write code & of healthcare delivery is still primarily build modules”

Intervener

Developer

Strategic Investor

Funder

  • Invests independently

  • Engages potential partners in needs analysis and testing

  • Aims for speed and success by working without a partner or on behalf of a future partner

“Invest, advise & monitor”

“Work alongside & take over if needed”

“Fund & ignore”

  • Invests with partner

  • Involved with partner in planning, and execution

  • Ensures success through ongoing, active participation or intervention when something goes wrong

  • Invests with Partners

  • Involved in project planning

  • Monitors progress of projects and quality of deliverables

    • Gated funding approach allows management of risk

  • Grants funding

  • Is uninvolved in project execution

  • Checks on status of phase-based deliverables

Infoway also provides leadership in setting the strategic direction and standards for EHR deployment across Canada

Infoway’s Investment Strategy

  • Infoway’s Role

  • Core Business

    • We strategically invest with public sector partners to develop, replicate and re-use compatible electronic health systems, thereby leveraging public funds, knowledge and results across Canada, to build a safer, more efficient healthcare system.


Nine strategic investment programs l.jpg
Nine Strategic Investment Programs of healthcare delivery is still primarily

End-user Adoption and Setting the Future Direction

Innovation & Adoption - $60m

The Electronic Health Record

Interoperable EHR - $175m

Public Health Systems$100m

Domain Repositories and Healthcare Applications

Drug Information Systems$185m

Laboratory Information Systems$150m

Diagnostic Imaging Systems$280m

Telehealth$120m

Cross Program Components

Client, Provider and Location Registries - $134m

Architecture and Standards

Infostructure - $25m

A 3-year joint technology and investment plan was developed with each jurisdiction that provides a long-term roadmap as to how these EHR components will rollout


Tying it all together l.jpg

Domain of healthcare delivery is still primarily

Domain

Repository

Repository

Domain

(Lab)

(Lab)

Domain

Domain

Client

Provider

Repository

EHR

Repository

Repository

Registry

Registry

(Diagnostic

(Lab)

(Pharmacy)

Imaging)

Common Services

HIAL

Communication Bus

Communication Bus

Communication Bus

Communication Bus

Patient Info

Patient Info

Tele-

Health

Drug Profile

Drug Profile

Patient History

Patient History

Diagnostic

Diagnostic

Laboratory

Laboratory

Imaging

Imaging

Tying it all together

EHR Solution (EHRS)

Domain

Domain

Domain

Domain

Repository

Repository

Repository

Repository

Client

Client

Provider

Provider

EHR

EHR

Registry

Registry

Registry

Registry

(Diagnostic

(Diagnostic

(Pharmacy)

(Pharmacy)

Imaging)

Imaging)

Common Services

Common Services

HIAL

HIAL

Communication Bus

Communication Bus

Communication Bus

Communication Bus

HIAL Provides standards-based message set for securely exchanging patient information

Applications

Public

Health

Surveillance

EMR

An interoperable EHR captures all key clinical data on one screen (role-based)


Progress l.jpg
Progress of healthcare delivery is still primarily


So where were we as of march 31 2004 l.jpg

WEST of healthcare delivery is still primarily ON QC EAST TERRITORIES

  • BC

  • AB

  • SK

  • MB

  • NB

  • NS

  • PE

  • NL

  • YK

  • NT

  • NU

  • EHR

  • Telehealth

  • Laboratory

INVESTMENT PROGRAMS

  • Drug

  • DI

  • Provider Reg.

  • Client Reg.

So Where Were We?As of March 31, 2004

Phase 0/1 Projects

Phase 2 Projects

Completed


So where are we as of march 31 2005 l.jpg

  • BC of healthcare delivery is still primarily

  • AB

  • SK

  • MB

  • NB

  • NS

  • PE

  • NL

  • YK

  • NT

  • NU

  • iEHR

  • Telehealth

  • Telehealth

  • Laboratory

  • Drug

INVESTMENT PROGRAMS

  • DI

  • Provider Reg.

  • Client Reg.

  • Public Health

So Where Are We?As of March 31, 2005

Phase 0/1 Projects

Phase 2 Projects

Completed


Where will we be as of march 31 2006 l.jpg
Where Will We Be? of healthcare delivery is still primarily As of March 31, 2006

WEST ON QC EAST TERRITORIES

WEST ON QC EAST TERRITORIES

WEST ON QC EAST TERRITORIES

  • BC

  • AB

  • SK

  • MB

  • NB

  • NS

  • PE

  • NL

  • YK

  • NT

  • NU

  • Public Health

  • Telehealth

  • Telehealth

  • iEHR

  • Laboratory

INVESTMENT PROGRAMS

  • Drug

  • DI

  • Provider Reg.

  • Client Reg.

Phase 0/1 Projects

Phase 2 Projects

Completed


Infoway s projects providing value coast to coast l.jpg

Legend of healthcare delivery is still primarily

Registries

Diagnostic Imaging

Drug Info Systems

Lab Info Systems

Telehealth

Interoperable EHR

Public Health Surv.

Infoway’s Projects Providing Value Coast to Coast

146 active and completed projects valued at $536 million in all 9 investment programs. The 88 projects jointly developed with provinces and territories are shown. In addition, 58 national projects are also underway.

Q3 FY 2005/06


Canada health infoway24 l.jpg

900 of healthcare delivery is still primarily

900

900

Program Commitments

800

800

800

700

700

700

600

600

600

500

500

500

400

400

400

Project Approvals

300

300

300

200

200

200

Project Expenditures

100

100

100

0

0

0

2001/02

2001/02

2001/02

2002/03

2002/03

2002/03

2003/04

2003/04

2003/04

2004/05

2004/05

2004/05

2005/06

2005/06

2005/06

2006/07

2006/07

2006/07

2007/08

2007/08

2007/08

2008/09

2008/09

2008/09

2009/10

2009/10

2009/10

2010/11

2010/11

2010/11

2011/12

2011/12

2011/12

Project Commitments

Project Commitments

Project Approvals

Project Approvals

Project Expenditures

Project Expenditures

Project Commitments

Project Approvals

Project Expenditures

Canada Health Infoway

  • Infoway’s Investment Progress

    • Infoway has an investment target range of $275 - $375 million in project approvals for 2005-06. On a cumulative basis this will result in $646 million or 54% of the $1.2 billion that Infoway has committed to its nine investment programs.


Approach l.jpg
Approach of healthcare delivery is still primarily


Infoway s investment strategy27 l.jpg
Infoway’s Investment Strategy of healthcare delivery is still primarily

  • Infoway’s Business Model

    • Infoway’s business model is built on seven complementary strategies which is allowing Canada’s provinces and territories to accelerate the implementation of interoperable electronic health records while minimizing costs and risk.

  • Targeted Investment Programs - focused on nine investment programs

  • Collaboration with Health Ministries and Other Partners - joint planning with health

    ministries and other parties to ensure alignment

  • Co-Invest with Public Sector Partners - share the investment in projects with our

    public sector partners

  • Leveraged Investment - invest in solutions that can be replicated across the country

  • Form Strategic Alliances with the Private Sector - form strategic alliances with the

    private sector to implement standards-based commercial solutions that reduce cost and risk

  • Focus on End-User Acceptance - early and ongoing focus on end-users to gain

    acceptance and adoption

  • Measure Benefits and Adjust - continually measure the benefits achieved against those

    planned and make the necessary adjustments


Specific approaches l.jpg
Specific Approaches of healthcare delivery is still primarily

  • Joint Planning (Rolling 3 years)

  • Change Management

  • Common Solutions Architecture

  • Common ICT Standards

  • Common Procurement/National Pricing

  • Knowledge Sharing

  • Gated Reimbursement

  • - implementation

  • - adoption targets


Challenges l.jpg
Challenges of healthcare delivery is still primarily


Challenges30 l.jpg
Challenges of healthcare delivery is still primarily

Adoption / Acceptance by healthcare professionals

Infoway capitalization insufficient to achieve objectives

Ability of some jurisdictions to support several programs

Benefits evaluation

Interoperable standards

Privacy

Managing Multi-Million Dollar EHR Projects


Slide31 l.jpg

The Opportunities of healthcare delivery is still primarily

Better Prescribing Practices

Reduced Wait Times

Improved access to care in

rural and remote communities

Complete and accurate clinical information to diagnose and treat

Less administrative burden,

More time for patients


Slide32 l.jpg

Thank you of healthcare delivery is still primarily


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