The Canadian Electronic Health Records Strategy for Better Care Delivery - PowerPoint PPT Presentation

View by Category
About This Presentation
Title:

The Canadian Electronic Health Records Strategy for Better Care Delivery

Description:

Laboratory Information Systems. Client, Provider and Location Registries - $135m ... Laboratory Information Systems. To allow clinicians to view laboratory ... – PowerPoint PPT presentation

Number of Views:161
Avg rating:3.0/5.0
Slides: 56
Provided by: luc76
Learn more at: http://medical.nema.org
Category:

less

Write a Comment
User Comments (0)
Transcript and Presenter's Notes

Title: The Canadian Electronic Health Records Strategy for Better Care Delivery


1
The Canadian Electronic Health Records Strategy
for Better Care Delivery
  • David A. Koff MD
  • McMaster University, Hamilton
  • ZHE FENG MD
  • Sunnybrook Health Science Centre, Toronto

2
Geographic Specificities
Average distance that people have to travel to
reach the nearest specialist living in the same
province or territory. Specialists tend to be
found in urban areas. Rural and northern
residents must travel considerable distances to
see specialists.
gt 100 km
3
Definitions
  • Telehealth is the use of communications and
    information technology for clinical care,
    education and healthcare services at a distance.
  • Telemedicine is the use of communication and
    information technologies to provide or support
    clinical care at a distance.
  • Teleradiology is the electronic transmission of
    diagnostic imaging studies from one location to
    another for the purposes of interpretation and/or
    consultation.
  • Teleradiology represents 90 of telemedicine
    activity.
  • More and more telehealth transactions include
    transmission of images.

4
Numerous projects
  • All Provinces and Territories involved in
    Telehealth.
  • Over 100 active telehealth programs.
  • Many of those programs have to include medical
    images.
  • Heterogeneous networks and multi-vendor programs
    and telecommunications services.

5
A few examples
  • Health Infostructure Atlantic Project
  • Interprovincial Integration of Images and
    Information (TELE-i4)
  • Images shared within the 4 Atlantic Provinces
  • North Network
  • 80 sites through northern and central Ontario
  • Alberta Wellnet
  • Integrated system-wide health information
  • Provincial PACS project.

6
Electronic Health Record
  • Canada is focusing its efforts in improving
    healthcare by implementing an interoperable
    electronic health records.

7
What is an EHR ?
  • An electronic health record provides each
    individual in Canada with a secure and private
    lifetime record of their health history.
  • Electronic health record systems provide
    authorized healthcare professionals with rapid
    access to patient information anywhere anytime.
  • Today, only 9 of Canadians have an electronic
    health record.

8
Canada Health Infoway
  • Canada Health Infoway
  • Launched mid-2001, Infoway is an independent
    federally funded agency that works with the 10
    provinces and 3 territories to invest in
    electronic health records projects.
  • Mission
  • To foster and accelerate the development and
    adoption of electronic health information systems
    to have an interoperable EHR in place across 50
    percent of Canada by the end of 2009 and all
    Canadians covered by 2016.

9
Canada Health Infoway
  • Infoway acts as a strategic investor
  • invests with partners and funds 50 or more of
    the cost of a project
  • is involved in project planning
  • monitors progress of projects and quality of
    deliverables gated strategy links reimbursement
    to achievement of milestones.

10
Infoways Investment Programs
End-user Adoption and Setting the Future Direction
Innovation Adoption - 60m
The Electronic Health Record
Interoperable EHR - 175m
Laboratory Information Systems150m
Public Health Systems100m
Diagnostic Imaging Systems310
Drug Information Systems185m
Domain Repositories and Healthcare Applications
Telehealth150m
Cross Program Components
Client, Provider and Location Registries - 135m
Architecture and Standards
Infostructure - 25m
11
Infostructure
End-user Adoption and Setting the Future Direction
Innovation Adoption - 60m
The Electronic Health Record
Interoperable EHR - 175m
Laboratory Information Systems150m
Public Health Systems100m
Diagnostic Imaging Systems310
Drug Information Systems185m
Domain Repositories and Healthcare Applications
Telehealth150m
Cross Program Components
Client, Provider and Location Registries - 135m
Architecture and Standards
Infostructure - 25m
12
Infostructure
  • Development of common solution architecture and
    standards to ensure interoperability of EHR.
  • Provide to hospitals and vendors the business and
    technical guidelines
  • Toolkits technical and business knowledge (case
    studies, templates, plans, reports, etc)
  • EHRS Blueprint, including the Privacy and
    Security requirements.

13
The Use of Standards
  • Teleradiology
  • Standards and Guidelines for Teleradiology - CAR
  • ACR Technical Standards for Teleradiology - ACR
  • Integration
  • IHE (Integrating the Healthcare Enterprise)
  • Diagnostic Imaging Data
  • DICOM
  • JPEG and JPEG 2000
  • TIFF
  • BMP
  • Electronic Health Information
  • HL7 v3
  • CCR (Continuity of Care Record) - ASTM
    International
  • Multimedia Conferencing
  • ITU-T H.323/H.320 for video and audio
  • ITU-T T.120 for data

14
The Use of Standards
  • Launched in 2006, the Standards Collaborative is
    a new Canada-wide coordination structure created
    to support and sustain health information
    standards in Canada.
  • Housed at Infoway, the Standards Collaborative
    will be responsible for the implementation,
    support, education, conformance, and maintenance
    for EHR standards currently being developed by
    Infoway.

15
The Use of Standards
  • The Standards Collaborative also encompasses
    several standards initiatives formerly managed by
    the Canadian Institute for Health Information
    (CIHI)
  • Partnership for Health Information Standards,
  • HL7 Canada,
  • Canada's participation in DICOM (Digital Imaging
    and Communications in Medicine) and,
  • in conjunction with the Canadian Standards
    Association (CSA), the secretariat to the
    Canadian Advisory Committee to ISO/TC 215.

16
Client, Provider and Location Registries
End-user Adoption and Setting the Future Direction
Innovation Adoption - 60m
The Electronic Health Record
Interoperable EHR - 175m
Laboratory Information Systems150m
Public Health Systems100m
Diagnostic Imaging Systems310
Drug Information Systems185m
Domain Repositories and Healthcare Applications
Telehealth150m
Cross Program Components
Client, Provider and Location Registries - 135m
Architecture and Standards
Infostructure - 25m
17
Client, Provider and Location Registries
  • Answers to the need to accurately identify
    patients, health professionals and healthcare
    facilities
  • Client Registries contain patient health
    identification number and demographic
    information.
  • Provider Registry identification of doctors,
    pharmacists, dentists, nurses, etc
  • Service Delivery Location Registry hospital,
    clinics, physician offices.

18
Drug Information Systems
End-user Adoption and Setting the Future Direction
Innovation Adoption - 60m
The Electronic Health Record
Interoperable EHR - 175m
Laboratory Information Systems150m
Public Health Systems100m
Diagnostic Imaging Systems310
Drug Information Systems185m
Domain Repositories and Healthcare Applications
Telehealth150m
Cross Program Components
Client, Provider and Location Registries - 135m
Architecture and Standards
Infostructure - 25m
19
Drug Information Systems
  • All data concerning a patients medication
    history prescribed and dispensed drugs,
    allergies, ongoing drug treatment.
  • Drug and drug-interaction checks performed
    automatically and added to the patients' drug
    profiles in their Electronic Health Record (EHR).
  • Provide physicians and pharmacists with data to
    support appropriate and accurate prescribing and
    dispensing.

20
Laboratory Information Systems
End-user Adoption and Setting the Future Direction
Innovation Adoption - 60m
The Electronic Health Record
Interoperable EHR - 175m
Laboratory Information Systems150m
Public Health Systems100m
Diagnostic Imaging Systems310
Drug Information Systems185m
Domain Repositories and Healthcare Applications
Telehealth150m
Cross Program Components
Client, Provider and Location Registries - 135m
Architecture and Standards
Infostructure - 25m
21
Laboratory Information Systems
  • To allow clinicians to view laboratory results
    and reports from all hospital, community and
    public health laboratories.
  • The results will be linked to patients'
    Electronic Health Records (EHR).

22
Diagnostic Imaging Systems
End-user Adoption and Setting the Future Direction
Innovation Adoption - 60m
The Electronic Health Record
Interoperable EHR - 175m
Laboratory Information Systems150m
Public Health Systems100m
Diagnostic Imaging Systems310
Drug Information Systems185m
Domain Repositories and Healthcare Applications
Telehealth150m
Cross Program Components
Client, Provider and Location Registries - 135m
Architecture and Standards
Infostructure - 25m
23
Diagnostic Imaging Systems
  • Digital Image Repositories
  • Electronic distribution of DI results to all
    facilities, referring community physicians and
    specialists over reliable networks (all studies,
    any time, any where).
  • Shared DI Repository scaleable to 1.5 million
    studies/year (single/multi jurisdiction or large
    regions) integrated with IHE-compliant RIS
    solution(s).

24
Repository Current Status
22 shared PACS/Archive Solutions (DI-r)
Target
Planning
Completed
Implementation
25
Benefits of DI-r
  • Patient impact
  • Improve report turnaround time
  • Reduction in duplicate exams (132M/year in
    Ontario)
  • Reduction in patient transfers
  • Resources impact
  • Improve radiologist productivity by 25-28
  • Improve technologist productivity by 10-12
  • Improve clinician productivity

26
Benefits of DI-r
  • Cost impact
  • Reduction in film related costs (3.2-4 B)
  • Reduction in stand alone versus shared PACS
    system savings estimated at 40.
  • For the healthcare system
  • Overall cost 7.4 Billion but delivers 9.1
    Billion in benefits over 10 years.

27
Diagnostic Imaging Systems
  • Filmless working environment for all procedure
    types (CT, MR, X-Ray, ultra-sound, etc.)
  • Implementation of IHE profiles and EHR
    interoperability specifications (HL7/DICOM
    standards for image acquisition and report
    creation)
  • Use of optimal compression strategies for digital
    images.

28
Use of a shared XDS infrastructure to access
Radiology Reports and Images development of
XDS-I and related tools by IHE-Canada.
IHE Profiles
  • Between Radiology and
  • Imaging specialists
  • Non-imaging clinicians

Hospital
PACS Y
Radiology -to-Radiology
Radiology -to-Physicians
PACS Z
Imaging Center
Physician Practice
29
Image Compression
  • Storage volume
  • Even if the cost of storage is dropping, the
    savings are largely surpassed by the increasing
    amount of data.
  • The cost of operation remains high.
  • 40 million diagnostic imaging exams are performed
    annually in Canada.
  • With an average legal retention period of 7 years
    upon provincial regulations.
  • Use of irreversible compression at 101 could
    save M100 million per year.

30
Image Compression
  • and transmission times
  • and if access to high bandwidth gets more
    available in local hospital networks, it is still
    premature to expect any health professional to
    use 100 mbps connections on their computers.
  • EHR networks cannot support large medical images
    and timely access to diagnostic images requires
    adequate level of compression.

31
Image Compression
  • The Canadian Association of Radiologists
    PACS/Teleradiology committee has accepted the
    principle of irreversible (lossy) compression
    for use in primary diagnosis and clinical review,
    using DICOM JPEG or JPEG-2000 compression
    algorithms, at specific compression ratios set by
    image type.
  • Adoption conditional to the results of a large
    scale evaluation study.

32
Image Compression
  • This study has been performed at Sunnybrook,
    supported by a grant from Canada Health Infoway.
  • Prior to that, CHI had commissioned 2 literature
    reviews and 2 legal assessments.
  • Radiologists have been enrolled from 9 out of 10
    Canadian Provinces.

33
Methodology
  • Based on previous studies, our evaluation
    resulted from the association of 2 accepted
    methods
  • Objective measurement of diagnostic accuracy with
    ROC analysis
  • Subjective image comparison with
    original-revealed forced choice (JND)

34
Methodology
  • 3 readers per session, 23 sessions, more than 100
    readers in total from all across Canada.
  • Had to read the images on the DICOM compliant,
    calibrated workstation they use in their daily
    activity.
  • The workstation had to be connected to the
    Internet ideally.
  • The answers were filled on-line and directly
    transferred to our server.

35
Diagnostic Accuracy
GROUND GLASS OPACITY
36
Comparison side-by-side
JPEG 2000 151 ORIGINAL
37
Examples
JPEG 2000 201 ORIGINAL
PNEUMOTHORAX
38
Examples
JPEG 2000 251 ORIGINAL
CALCIFICATIONS
39
Results
For 18 anatomical regions/modalities, there was
no difference noted, but discrepancies were noted
in 3 occurrences.
40
Results
41
Results
42
Results
43
J2K vs. JPG
J2K 151
JPEG 151
Noticeable degradation
No noticeable degradation
Difference in performance is due to the fact that
JPEG 2000 has good spatial resolution and
discards the low energy high-frequency
coefficients during quantization.
44
Recommendations
  • Lossy compression can be used at the lowest
    levels of compression tested, as there was no
    significant loss of diagnostic information at
    those levels.
  • No difference between Lossy JPEG and JPEG 2000 at
    the lowest levels of compression.

45
Results recommended values
CR/DR CT US MR NM MG
Angio 10-15 16-24
Body 20-30 JPEG 10-15 J2K 10 8-12 16-24 9-11
Breast 8-12 16-24 15-25
Chest 20-30 10-15
MSK JPEG 20-30 J2K 20 10-15 8-12 16-24
Neuro JPEG 8-12 J2K 8 16-24
Ped 20-30 10-15 8-12 16-24 9-11
46
Public Health Systems
End-user Adoption and Setting the Future Direction
Innovation Adoption - 60m
The Electronic Health Record
Interoperable EHR - 175m
Laboratory Information Systems150m
Public Health Systems100m
Diagnostic Imaging Systems310
Drug Information Systems185m
Domain Repositories and Healthcare Applications
Telehealth150m
Cross Program Components
Client, Provider and Location Registries - 135m
Architecture and Standards
Infostructure - 25m
47
Public Health Systems
  • Solutions that support the identification,
    management and control of infectious disease
    cases and outbreaks that pose a threat to the
    public's health.
  • In March 2004, taking into account the lessons
    learned from the SARS outbreak and public concern
    about the ability of public health authorities to
    deal with emerging communicable disease threats,
    the federal government assigned Infoway the task
    of developing a communicable disease surveillance
    system in partnership with the provinces and
    territories.

48
Telehealth
End-user Adoption and Setting the Future Direction
Innovation Adoption - 60m
The Electronic Health Record
Interoperable EHR - 175m
Laboratory Information Systems150m
Public Health Systems100m
Diagnostic Imaging Systems310
Drug Information Systems185m
Domain Repositories and Healthcare Applications
Telehealth150m
Cross Program Components
Client, Provider and Location Registries - 135m
Architecture and Standards
Infostructure - 25m
49
Telehealth
  • Electronic solutions that facilitate the delivery
    of health information and services between
    patients and providers regardless of distance.
  • Multiple projects based on
  • Geographic (tele-education, home healthcare,)
  • Cultural (First Nations, language minorities)
  • Clinical (post cardiac surgery, wound care
    assistance, telepsychiatry)
  • Management Models as well as Technology and
    Standards

50
Interoperable EHR
End-user Adoption and Setting the Future Direction
Innovation Adoption - 60m
The Electronic Health Record
Interoperable EHR - 175m
Laboratory Information Systems150m
Public Health Systems100m
Diagnostic Imaging Systems310
Drug Information Systems185m
Domain Repositories and Healthcare Applications
Telehealth150m
Cross Program Components
Client, Provider and Location Registries - 135m
Architecture and Standards
Infostructure - 25m
51
Interoperable EHR
  • Implementation of solutions that allow clinicians
    to view and update an integrated patient-centric
    health record anywhere at any time.
  • Supports EHR initiatives that demonstrate value
    and benefits in a specific health practice domain
    integrating information across multiple points of
    service and multiple caregivers.
  • Commercially available integrated EHR solutions
    will be deployed regionally or supra-regionally
    to demonstrate interoperability, scalability and
    replicability.

52
Innovation Adoption
End-user Adoption and Setting the Future Direction
Innovation Adoption - 60m
The Electronic Health Record
Interoperable EHR - 175m
Laboratory Information Systems150m
Public Health Systems100m
Diagnostic Imaging Systems310
Drug Information Systems185m
Domain Repositories and Healthcare Applications
Telehealth150m
Cross Program Components
Client, Provider and Location Registries - 135m
Architecture and Standards
Infostructure - 25m
53
Innovation Adoption
  • Infoway supports initiatives that bring clinical
    value and optimize the use of EHR
  • Knowledge portals
  • Evidence-based medicine
  • Computerized physician order entry and clinical
    decision support systems.
  • Disease management solutions.

54
Conclusion
  • Canada started late in the implementation of a
    nationwide Electronic Health Record, but has
    developed a tremendous effort to get 50 of the
    population covered by end of 2010 through a
    number of initiatives supported by Canada Health
    Infoway.
  • Well do our best to reach this goal.

55
Conclusion
  • Thank you.
About PowerShow.com