From theory to reality:

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• From theory to reality
• Moving EHR ahead in Canada

BCHIMPS Presentation by Trevor Hodge Senior
Vice President, Canada Health Infoway May 4,
2007
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Overview

• The need for EHR in Canada (the rhetoric)
• Infoways mission, approach, programs (the
  theory)
• Progress across Canada (the reality)
• Supporting health system uses (the reality)
• Value to stakeholders (the theory)
• Before we get too smug (the rhetoric)

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• The need for EHR in Canada

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The need for EHR
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The need for health information
Providers, managers, patients, public are
demanding more IT has potential to enable
solutions to address pressures
Consumerism is growing
Population is aging
Care settings are shifting
Resource pressures greater
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Canadian investments in healthcare IT
5.4
Annual IT spend Per cent of total
budgets/revenues
4.7
4.5
4.0
Canadas healthcare system under-invests in IT
relative to other healthcare providers and
information management industries
3.4
2.9
Range of HC IT spend of Canadian jurisdictions
2.0
1.5
Calgary Regional Health Authority
Professional services
Education
US HC providers
UK health-care
US banking/ financial services
Operating and capital Gartner estimate as
of revenues assumes providers working on a
non-profit basis Predicted rise to 4 from
1.5 in 2004 Sources Information Technology
Association of Canada, 2004 Gartner
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What is an EHR?
What is an EHR?
An electronic health record (EHR) is a secure and
private lifetime record of an individuals
health and care history, available
electronically to authorized health providers.
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Sample of an EHR
Patient information
Results and images
Medical alerts
Medication history
Interactions
Immunization
Problem list
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• Infoways mission, approach, programs

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About Infoway

• Infoway was established by the First Ministers of
  Canadas federal, provincial and territorial
  governments in 2001
• Infoway is a not-for-profit corporation
• Funded by the Government of Canada
• Infoways members are Canadas 14 federal,
  provincial and territorial Deputy Ministers of
  Health
• Independent Board of Directors

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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 Canadians

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Infoway business strategies

• Participate in healthcare renewal
• Collaborate with our partners
• Target the investments (7525 formula)
• Support solution deployment
• Promote solution adoption and benefit realization

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Infoway investment programs
Innovation and Adoption 60 million
Innovation and Adoption - 60 million
Chronic Disease
Wait Times
Cancer
Public Health Surveillance 100 million
Patient Access xxx million??
Telehealth120 million
Mental Health
Primary Care
Patient Safety
Interoperable EHR 175 million
BASIC ELEMENTS OF EHR
Laboratory Systems 150 million
Diagnostic Imaging 310 million
Registries 134 million
Drug Systems 185 million
Infostructure 32 million
Note the recent announcement of 400M for
Patient Access has yet to be allocated by the
Infoway Board. The funding is for improving
patient access including electronic health access
and patient wait times
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Focus on standards and interoperability

• Common architecture accepted and in use by
  jurisdictions
• Updated architecture includes privacy and
  security
• New Infoway Standards Collaborative
• Intensive standards development and
  implementation underway

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EHR conceptual architecture
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EHR Linked jurisdiction networks
Distributed, message-based, peer-to-peer network
of EHRS systems
EHRS
EHRS
EHRS
EHRS
EHRS
EHRS
EHRS
EHRS
EHRS
EHRS
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National preferred solution agreements

• Client Registry Initiate Systems
• Provider Registry - WHIC
• Diagnostic Imaging AGFA, Phillips, Fuji,
  McKesson (others in progress)
• Drug IBM, Emergis, Deltaware
• Lab in progress
• iEHR in progress, includes repository, HIAL and
  EHR viewer
• Telehealth in progress
• Public Health Surveillance IBM/STC

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Cost Avoidance from Procurement
Estimated costs avoided by Infoway and
jurisdictions in acquiring EHR systems through
end of 2009 Millions
235-310
20-25
135-165

• Existing procurement efforts will avoid 135
  million-165 million
• If national pricing initiatives and shared
  services arrangements are applied to forecasted
  projects, an additional 100 million-125
  million in costs could also be avoided
• These benefits will be shared between Infoway
  and the jurisdictions

100-125
80-100
55-65
80-120
135-185
Demand consolidation in DI, PRS, CRS, PHS
National pricing in Drug, iEHR, Labs
Shared services
Total cost avoidance
Potential upside in forecasted initiatives
Costs avoided through existing initiatives
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Progress across Canada
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Program activity summary (March 31, 2007)
227 active and completed projects valued at
1.175 billion in all nine investment programs

• Legend
• ? Registries
• ? Diagnostic Imaging
• ? Drug Info Systems
• ? Lab Info Systems
• ? Telehealth
• ? Interoperable EHR
• ? Public Health Surveillance
• ? Innovation Adoption? Number of Projects

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Significant progress is being made
March 2004 125 M
WEST EAST TERRITORIES
ON
QC
Telehealth
iEHR
Laboratory
Drug
DI
Provider Reg.
Client Reg.
March 2007 1.176 B
WEST
ON
QC
EAST
TERRITORIES
WEST
ON
QC
EAST
TERRITORIES
ON
QC
Public Health
Telehealth
Telehealth
iEHR
Laboratory
Drug
DI
Provider Reg.
Client Reg.
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Progress to date
Jurisdictional progress to March 31, 2007
Client
Provider
PHS

registry
Jurisdiction
registry
Lab
iEHR
Drug
DI
registry
Jurisdiction
registry
Lab
iEHR
Drug
DI
STATUS
EHR for 27 of the Canadian Population In flight
AB
AB
Complete
PE
Adoption
PE
Implementation
BC
BC
Planning
SK
SK
Forecast
MB
MB
NL
NL
ON
ON
NS
NS
QC
QC
NB
NB
NT
NT
YT
YT
NU
NU
Baseline
0
0
5
0
0
38
17
6
Completed as at FY 06-07
4
4
29
0
7
0
Adoption underway as at FY 06-07
3
3
0
0
5
10
33
Percent Total
39
7
12
27
29
0
50
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Progress this year
Forecasted Jurisdictional progress to March 31,
2008
Client
Provider
PHS
Jurisdiction
Lab
iEHR
Drug
DI
Jurisdiction
Lab
iEHR
Drug
DI
Jurisdiction
Lab
iEHR
Drug
DI
registry
registry
registry
registry
registry
registry
Status
Status
Status

Complete
Complete
Complete
PE
PE
PE
Adoption
Adoption
Adoption
AB
AB
AB
Implementation
EHR for 52 of the Canadian Population In Flight
Planning
Planning
Planning
BC
BC
BC
Forecast
Forecast
Forecast
SK
SK
SK
NL
NL
NL
QC
QC
NS
NS
NB
NB
NB
NB
MB
MB
MB
MB
ON
ON
NT
NT
NT
YT
YT
YT
NU
NU
NU
39
7
12
0
0
0
27
29
50
Percent Total at FY 06-07
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Forecasted Complete as at FY 07
-
08
8
8
2
2
2
0
4
2
2
2
0
4
2
2
2
0
4
10
10
10
Adoption underway as at FY 07
-
08
4
0
19
0
Adoption underway as at FY 07
-
08
4
0
0
Adoption underway as at FY 07
-
08
4
0
0
1
0
13
1
0
13
1
0
13
Percent Total as at FY 07-08
51
9
33
38
31
0
67
9
33
0
67
9
33
0
67
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Different stages of progress
All 14 provincial, territorial and federal
governments agreed to adopt a single, Canada-wide
public health surveillance solution
NEWFOUNDLAND LABRADOR Province-wide
Progress
BRITISH COLUMBIA Leveraging PastInvestments
for an EHR
QUEBEC Networking 62 Hospitals
MANITOBA Telehealth Calling
ALBERTA Netcare Alberta-bound
PEI Island-wide IEHR
ONTARIO Keeping Tabson Labs
NEW BRUNSWICK Telehealth Calling
SASKATCHEWAN Checks MedSafety
NOVA SCOTIA Farewell to Film
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Leveraging EHR for innovative healthcare
EHR
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The value to stakeholders
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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
• Increased patient participation in home care

ACCESS

• Improved interpretation of diagnostic and
  laboratory results
• Decreased adverse drug events
• Decreased prescription errors
• Increased speed and accuracy in detecting
  infectious disease outbreaks

QUALITY

• Increased access to integrated patient
  information
• Reduced duplicate tests and prescriptions
• Reduced physician prescription call-backs
• Reduced patient and provider travel costs

PRODUCTIVITY
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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
Quality

• Patient safety

Use

• Appropriateness/

effectiveness
Use Behavior/

• Health outcomes

Pattern
Self Reported Use
Intention to Use
Access

• Ability of patients/providers

to access services

• Patient and caregiver

participation
Productivity

• Efficiency

• Care coordination

• Net cost

Based on the Delone McLean IS Success Model
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Infoway is adding value at every step

• Joint governance
• Joint planning
• Predictable funding
• Common solutions architecture
• Common ICT standards
• Accountable spend

• Common procurement
• Common solutions
• National pricing
• Shared services
• Knowledge sharing
• Global leaders, exporting expertise

A mid-term independent performance evaluation
conducted in 2005 and a 2006 review commissioned
by Health Canada both validated and supported
Infoways value-added role.
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• Before we get too smug

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The future in focus
Business systems

• Public health surveillance for comprehensive
  pandemic management
• Chronic disease management for advanced case
  management of key chronic diseases
• Wait time management
• Patient self-care to support patients and their
  caregivers at home
• Performance management to ensure sustainable
  patient care delivery

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Priorities to 2015
Largest investment required
1
Finish what started in electronic health records
and public health surveillance
Foundational Elements
2
Implement electronic medical records in physician
offices and physician order entry systems in
hospitals
3
Enable public visibility for wait times and access
Facilitate patient self-care and empowerment
4
Additional Elements
Trial and perfect more advanced functionality in
wait times and chronic disease management
5
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Hurdles to overcome

• Clinician adoption/patient engagement
• Jurisdictional capacity
• Interoperability/vendors
• Recapitalization

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The promise

• Increased patient participation in care
• Well-managed chronic illness
• Improved access to care in remote and rural
  communities
• Less adverse drug events
• Better prescribing practices
• Reduced wait times

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Thank you!
CANADA HEALTH INFOWAY Moving EHR ahead in Canada