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ITAC Health's Alberta e-Health Consultation Breakfast. Mark Brisson, Alberta Health and Wellness October 20, 2009. Proposed Agenda for Presentation. Alberta's Health System – Context Provincial IM/IT Integrated Planning Focus Example: Personal Health Portal Key Business and IM/IT Priorities.

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ITAC Health's Alberta e-Health Consultation Breakfast

Mark Brisson, Alberta Health and Wellness

October 20, 2009


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Proposed Agenda for Presentation

  • Alberta's Health System – Context

  • Provincial IM/IT Integrated Planning Focus

    • Example: Personal Health Portal

  • Key Business and IM/IT Priorities



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Current Challenges in Alberta’s Health System

  • > 35% of provincial spending and growing

  • Dependence on hospital and nursing home care, yet limited community capacity

  • Close proximity and limited capacity of small hospitals

  • Health provider supply and productivity

  • Little coordination/integration across the health system


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An Elderly Diabetic and their interactions with the Healthcare System

Internist/

Endocrinologist

4

1

5

Ophthalmologist

7

3

2

6

HealthLink

Family Phys

Diabetes Education

Centre

Client/Patient

Diagnostic Services

Public Health (flu)

14

11

Home Care

13

10

Acute Care

Home Dialysis

8

Pharmacy

12

9

  • Legend:

  • 1. Annual flu shot

  • 2. Call HealthLink for advice

  • 3. HealthLink refers to GP

  • Referral to Diabetes

  • Education Centre

  • 5. Referral to specialist

  • 6. Referral to Ophthalmologist

  • 7. Orders for diagnostics

  • 8. Admission to acute care

  • 9. Discharge medications

  • 10.Home dialysis

  • 11.Discharge care to GP

  • 12.In-Home Care


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Drivers of Demand and Utilization Healthcare System

  • Population growth and aging

    • Patients over the age of 65 drive 45% of annual growth.

  • Average utilization of Alberta’s large acute care hospitals is 90%

  • Over half of small hospitals have utilization below 75%

  • Over 10% of all acute care beds are “blocked” by patients waiting for long term care or supportive living

  • Chronic disease management


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Health Spending - (2009-10) Healthcare System

  • $12.9 billion

  • $3 billion for physician services

  • > $8 billion to Alberta Health Services (AHS)

  • > $5 billion on staff salaries & benefits

  • AHS spends $29.9 million per day

  • If we continue at this rate of spending, AHS’s budget will grow by almost 200% by the year 2020


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-6.2% Healthcare System

-6.3%

CONTROLLING COSTS WILL REQUIRE ALBERTA TO “BEND THE TREND”

Projected former RHA spending 2008-2020, baseline and optimal cases

$ billions

25,000

Projection assuming historical growth - base

Projection assuming historical growth – optimistic scenario

20,000

AHW Projections – base scenario

15,000

AHW Projections – optimistic scenario

10,000

08

09

10

11

12

13

14

15

16

17

18

19

20

Year

Source: AHW Economics Unit; Health & Wellness 2008-11 Business Plan;


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Where have we been… Healthcare System

  • 120 hospital boards

  • 17 regional health authorities

  • 9 regional health authorities & 3 boards

  • 1 centralized model: Alberta Health Services


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AHW Healthcare System

Strategic/directional policy

Macrosystem design

Performance measurement

Monitoring, compliance and assurance

Funding

Capital recommendations and approvals to Treasury Board

AHS

Service delivery

Operational and workforce decisions

Operational policies

Allocation of funds to services

Performance management

Capital recommendations to AHW

Roles of AHW and AHS



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Alberta “I-Plan” – 2009 - 2015 Healthcare System

  • An integrated IM/IT strategy that covers provincially-funded healthcare IM/IT investments 2009-2015

  • Links overall business plans and strategies with detailed program/project plans

  • Does set provincial strategic directions for healthcare IM/IT

  • Includes specific progress/benefit measures that can be tracked to monitor execution of the Plan

  • To provide an accountability framework for monitoring progress in executing the Plan.

  • Is currently being finalized, with Health Information Executive Committee approval expected December 2009


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I-Plan Scope Healthcare System

  • Provincially-funded IM/IT initiatives undertaken by Alberta Health and Wellness, Alberta Health Services, Provider groups, or other organizations in major healthcare domains:

    • Point of service systems in hospitals and other healthcare delivery institutions (continuing care systems, public health systems);

    • Reference systems, provincial repositories and other components comprising an EHR infrastructure (registries, portal, pHIE);

    • Primary care and community medicine (e.g., EMRs);

    • Performance management and reporting systems


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I-Plan Context Healthcare System

Vision 2020 Strategic Guidance

Integrated I-Plan

Organizational tactical & strategic plans

Personal Health

Info Strategy

Pub Health

IT Strategy

Access/WTM

Strategy

EHR/NetCare

Strategy

POSP Plan

AHS IM/IT

Strategy

Pub Health

Project plans

PHP Project

Plans

EMR Imp’n Plans

Access/WTM

Project plans

AHS IM/IT

Project plans

EHR/NetCare

Project Plans

Infrastructure

Plans

Operational / project plans

Milestones, Metrics, benefits


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Stakeholders Engaged in I-Plan Healthcare System

  • Alberta Health and Wellness Business and IM/IT Division

  • Alberta Health Services Clinical and IT Group

  • Primary Care Initiative

  • Physician Office System Program

  • Alberta Medical Association

  • College of Physicians and Surgeons of Alberta

  • Alberta College of Pharmacists

  • Alberta Continuing Care Association

  • Alberta Pharmacists’ Association

  • Primary Care Networks

  • Office of the Information and Privacy Commissioner

  • Canada Health Infoway


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Provincial I-Plan Strategic Directions Healthcare System

Achieving universal access by providers to a complete set of clinical data domains in the EHR

Accelerating implementation of interoperable EMRs and other clinical management systems among independent providers

Ensuring seamless flow of information across continuum of care

Consolidation & standardization clinical business procedures, and supporting IM/IT

Increasing personal access to health information


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Example Initiative Description: Personal Health Portal Healthcare System

  • DOMAIN DESCRIPTION:

    • Personal Health Systems encompass all systems that grant patients access to clinical information. These systems allow patients to play an active role in partnering to manage their health and health care and provide them with information about themselves as well as the system in which they receive care. Patient portals are among the most common applications that can be used to fulfill this role and plans have already been developed to make his a reality in Alberta over the next 5 years.

  • SCOPE STATEMENT:

    • The Personal Health Portal (PHP) is envisioned to be an innovative (web-based and telephone service) application that will grant the public access to personalized information about wellness, health care, health conditions and treatments, health services, as well as many other health related aspects.

  • TARGET STATE:

    • The PHP will enable diverse health system providers to supply health content and services through the PHP framework, and assist in making the user experience as sea mless and coordinated as possible. Governance, standards, principles, and guidelines to support stakeholders in defining structures and content of the PHP will also be established.

  • VALUE/BENEFITS (business language, not project-related)

    • The PHP will enable Albertans to have improved ability to proactively manage their health and wellness, and access all health services that are available to them.

    • Patients and clinicians will have the improved ability to communicate and interact with one another, and

    • Patients can more effectively participate in managing their treatment.

    • Patients will also be able to effectively engage the support of and assist others in their treatment.


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Benefits / Clinical Value Healthcare System

Benefits could be assessed based on potential savings in the following six categories:

  • Diabetes savings

  • Congestive Heart Failure (CHF) savings

  • Appointment Scheduling savings

  • E Visits savings

  • Medication Renewal savings

  • Pre-encounter Questionnaire savings



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Business / Policy Priorities Healthcare System

  • Legislation to enable the delivery of health services using new models of care - MACH

  • Building community capacity – Home Care, Aging in Place

  • Creating a foundation of primary and public health

  • Funding health providers for performance

  • Implementing phase 2 of pharmaceutical strategy

  • Proposing new approaches to funding health services


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Key Project Focuses Healthcare System

AHW/AHS/AMA, etc..Joint

  • EHR (Portal/pHIE) Deployment / Capability Enhancements

  • Personal Health Portal

  • Identity and Access Management

  • Integration w/ AHS/Community Systems

  • Continued Physician Automation

  • Public Health

  • Continuing Care Technologies

AHW Primary

  • Provider Claims Reimbursement

  • Pharmaceutical Information Network – e-Prescribing

  • Performance Measurement / Data Warehousing / Health System Reporting

  • Registry Integration and Development

  • Health Workforce Forecasting