Richard C. Alvarez. President & CEO Canada Health Infoway.

1. The Canada Health Infoway Plan
1 Presentation by Richard Alvarez | President and CEO, Canada Health Infoway | February 22, 2008

2. Overview
• The Canadian context
• The need for EHR in Canada
• Infoway’s mission, approach, programs
• Progress across Canada
• Value to stakeholders
• Challenges and opportunities
2

3. The Canadian context
3

4. Canada is a large Geographic size
country Second largest country in the world
– 10M km2
6 time zones
7% of world’s renewable fresh
water supply
Governance
Federal, 10 provincial and 3
territorial governments
British Parliamentary system
A Commonwealth nation
4

5. Canada has a small Population Size and Location
population 32.6 million people - 3.3/km2 - among
the lowest population densities in world
76% urban; 24% rural
Most live within 400km of the US border
Ethnically Diverse
British Isles: 28%
French: 23%
Other European:15%
Non-European: 6%
Mixed heritage: 25%
Aboriginal: 3%
5

6. Canada is Internet Usage
connected 68% of Canadians use the internet (2005)
• 91% for e-mail
• 65% weather, travel
• 62% news, sports
• 55% banking, pay bills
Broadband Availability
Greatest broadband penetration in G7
76% of households using the internet in
Canada have high speed connectivity
and 24% use low speed dial-up options
(2005)
6

7. Health care is Cost
universally $148 billion business
available 10.4% of GDP
65% of costs for hospitals, physicians and
drugs
Financing
70% public funding
30% private funding, primarily for drugs,
dental and co-pay services
Most privately provided health care
services (e.g. physicians, laboratories,
diagnostic imaging) are publicly funded
7

8. Governance Governance
through shared Federal government sets and
administers national principles
accountability 13 provincial/territorial
governments plan, finance, manage,
evaluate health services
100+ health regions coordinate care
delivery over a set geographical
area
900+ hospitals manage care
Approximately 400,000 health care
professionals deliver care
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9. Health care drivers Pressure on the health system
Canada's population is aging fast
By 2011, an estimated 1.3 million
Canadians will be over the age of
80
Senior citizens will outnumber
children in about a decade
Health of baby boomers is declining
Health care spending is increasing
Wait times are a major issue
Political debates over private
sector role in health care delivery
9

10. Managing patient care in this complexity
10

11. Great expectations
What Canadians expect from their health care system:
• Accurate information that moves with them
• Communication between their various health care providers
• Protection of their privacy
• Input into decisions
• Elimination of undue risk
• Timely access/results
11

12. The need for EHR
For every… …in Canada
1,000 hospital admissions 75 people will suffer an adverse drug event
1,000 patients with an ambulatory encounter 20 people will suffer a serious drug event
1,000 patients discharged from hospital 90 people will suffer a serious adverse drug event
1,000 laboratory tests performed up to 150 will be unnecessary (range 50-150)
1,000 emergency department visits 320 patients have an information gap identified,
resulting in an average increased stay of 1.2 hours
1,000 Canadians recommended for influenza protection 370-430 are not vaccinated
12

13. The need for health information
management
Providers, managers,
Consumerism is patients, public are Population is aging
growing
demanding more
Pressures on IT has potential to
Care settings are
resources are
greater
enable solutions to shifting
address pressures
13

14. Annual IT spending Canada’s health care system is
so huge it would rank No. 10
Percentage of total budgets/revenues on the Fortune 500. It is more
than three times the size of
5.4 the country’s largest bank
(compared to total revenue).
Yet Canada under-invests in
4.7
4.5 health care IT relative to other
health care providers and
4.0 information management
industries.
3.4
2.9
1.5 – 2.0
Education US HC UK Calgary Professional US banking/ HC IT spend
providers health care Regional services financial Canadian
Health services jurisdictions
Authority
14

15. Benefits of EHRs
Quality
Quality Productivity
Productivity
•• Better continuity of care improves disease and
Better continuity of care improves disease and •• Provides time savings
Provides time savings
case management
case management •• Avoids unnecessary diagnostics, procedures and visits
Avoids unnecessary diagnostics, procedures and visits
•• Appropriate care adheres to standards
Appropriate care adheres to standards •• Optimizes coordination of human resources
Optimizes coordination of human resources
•• Prevention of adverse events and public health threats
Prevention of adverse events and public health threats
Improving quality improves health, Improving the productivity of health
reduces the burden on the system, care saves costs and makes optimal
and ensures optimal use of available human and other
use of capacity. resources.
Access
• Timely delivery of care
• 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
Reduced wait times
Capital cost : $10 billion to $12 billion
Benefits: $6 billion to $7 billion in savings annually
15

16. What is an EHR?
An electronic health record (EHR) is a secure and private lifetime
record of an individual’s health and care history, available
electronically to authorized health providers.
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17. Sample of an EHR
Results and images Patient information Medical alerts
Medication history
Interactions
Problem list Immunization
17

18. What Canadians think about EHRs
According to a recent, independent survey:
• 88 per cent support electronic records
• Canadians believe electronic health records will enable health
care providers to deliver better quality care
• Increase effectiveness for doctors 87 per cent
• Increase effectiveness for pharmacists 86 per cent
• Increase effectiveness for nurses, patients 81 per cent
and the health care system in general
* EKOS survey
18

19. Infoway’s mission,
approach, programs
19

20. Canada Health Infoway
• Canada Health Infoway created in 2001
• $1.6 billion in federal funding to date
• Independent, not-for-profit corporation
• Equally accountable to 14 federal/provincial/territorial governments
Goal:
By 2010, every province and territory and the populations they serve
will benefit from new health information systems that will help
modernize their health care system. Further, 50 per cent of Canadians
will have their electronic health record readily available to their
authorized professionals who provide their health care services.
20

21. 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
21

22. Infoway adopted a unique strategic
investor role
Strategic
Governor Funder Intervener Developer
investor
Set direction Fund and Invest, advise, Work alongside Write code
and standards ignore and monitor and takeover if and build
needed modules
Canada
UK
Denmark
Norway
Australia
New Zealand
Kaiser
Canada has a unique strategic investor
Veteran’s Affairs role that brings together a collaborative
engagement model, a shared
Primary role governance model, and a gated funding
Secondary role approach
22

23. Infoway business strategies
• Targeted investment programs
• Limited scope/goal
• Collaborate with health ministries and other partners
• Co-invest with public sector partners (75:25 formula)
• Leverage investment
• Form strategic alliances with the private sector
• Manage risk and ensure quality solutions
• Focus on end-user acceptance
• Measure benefits and adjust
23

24. Infoway programs
Ten investment programs totalling $1.636 billion
End-user Adoption
and Setting the Innovation and Adoption – $60 -million
Innovation and Adoption $60 million*
Future Direction
Health care Public Health Patient Access Cancer Chronic Diseases
Telehealth
Applications and Surveillance to Quality Care
$100 million $135 million $50 million Primary Care Mental Health
Innovation Projects
The Electronic
Interoperable EHR – $365 million
Health Record
Laboratory Diagnostic
Registries and Registries Drug Systems Systems Imaging
Domain Repositories $134 million $250 million $170 million $340 million
Architecture
Infostructure – $32 million
and Standards
24

25. Focus on standards and interoperability
• Common architecture
largely accepted by
jurisdictions
• Revised architecture
includes privacy and
security
• Comprehensive
standards collaboration
process
• New Infoway Standards
Collaborative
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26. The EHR architecture
JURISDICTIONAL INFOSTRUCTURE
Registries Data Ancillary Data EHR Data Data
& Services & Services & Services Warehouse
Client
Registry Immunization PHS Shared Drug Diagnostic Health
Laboratory
Management Reporting Health Record Information Imaging Information
Provider
Registry
Location
Registry Business EHR Message Normalization Terminology
Rules Index Structures Rules Repository
Longitudinal Record Services
Security Mgmt
Privacy Data Configuration
Data
Common Services
HIAL Communication Bus
Radiology
Public Health Pharmacy Lab System Hospital, LTC, Physician
Center EHR
Services System (LIS) CCC, EPR Office EMR
PACS/RIS Viewer
Public Health Pharmacist Radiologist Lab Clinician Physician/ Physician/
Provider Provider Provider Physician/
POINT OF SERVICE Provider
26

27. Electronic health records:
Linked jurisdiction networks
Distributed, message-based, peer-to-peer network of EHRS systems
EHRS EHRS EHRS EHRS EHRS EHRS EHRS
27

28. Progress across
Canada
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29. Summary of project activity
245 active and
245 active and
completed projects with
completed projects with
an estimated value of
an estimated value of
$1.332 billion as at
$1.332 billion as at
Dec. 31, 2007
Dec. 31, 2007
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Registries
29 Diagnostic Imaging Drug Info Systems Lab Info Systems Telehealth
Interoperable EHR Public Health Surveillance Innovation & Adoption Number of Projects

30. Planning
53 projects * Implementation
March 2004 = $125.2 million Completed Projects
* Includes 27 pan-Canadian projects not shown
30

31. Planning
Implementation
245 projects ** Completed Projects
December 2007 = $1.332 billion ** Includes 93 pan-Canadian projects not shown
31

32. Leveraging EHR for innovative health care
Quebec MSSS British Columbia Ministry of Health
Electronic patient evaluation and service Newfoundland & Labrador’s Eastern Health
planning solutions Pilots for province-wide adverse events reporting,
analysis and management
Sherbourne Health Centre
Remote electronic records for a Health Alberta Capital/Calgary Health
Bus serving the inner city homeless Public Regions
Health Patient Extend Alberta's iEHR and chronic
Sault Ste Marie Safety disease management solutions to
Link primary care providers
Primary primary care teams
and pharmacists to the Health
EMR/EHR
Care Grand River Hospital
EHR
Chronic Patient portal will provide access
to health information for cancer
Vancouver Island Health Disease and renal patients
Authority
EHR-based clinical decision support
tools to for Mental Health & Addictions Cancer Care Ontario
Services Cancer Computerized order entry and clinical
decision support to benefit cancer patients
Wait
Scarborough Hospital
Electronic self-entry (by patients) of patient Times
history in emergency department (ED) using
touch-screen kiosks
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33. The value to
stakeholders
33

34. 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
ACCESS
• Increased patient participation in home care
• Improved interpretation of diagnostic and laboratory results
• Decreased adverse drug events
• Decreased prescription errors QUALITY
• Increased speed and accuracy in detecting infectious
disease outbreaks
• Increased access to integrated patient information
• Reduced duplicate tests and prescriptions PRODUCTIVITY
• Reduced physician prescription call-backs
• Reduced patient and provider travel costs
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35. Benefits evaluation plan
To assess impact of Infoway investments in EHR solutions on health care
quality, productivity and access
Impacts identified will be used to:
• Demonstrate value
• Advance further investments
• Encourage end user adoption
• Highlight necessary adjustments in investment
35

36. 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
System quality Quality
•Patient safety
Functionality Use •Appropriateness/
Performance Use Behavior/ effectiveness
Security Pattern •Health outcomes
Self Reported Use
Intention to Use
Information Access
•Ability of patients/providers
quality to access services
Content •Patient and caregiver
Availability User participation
Satisfaction
Competency
Service User Satisfaction Productivity
Ease of Use •Efficiency
quality
Responsiveness •Care coordination
•Net cost
Based on the Delone & McLean IS Success
Model
36

37. Good news for the Canadian economy
Investment in EHR is not a drain on government treasuries
• Direct and indirect investments
• Tax revenue
• Domestic industry development
• According to one recent study, EHR activity will create 37,000
jobs by 2010 or the equivalent of $2 billion in new labour
income for Canadians
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38. Value to jurisdictions/ Value to patients
governments
• Cost avoidance • Diagnostic imaging
• Quality • Drug information systems
• Access • Chronic care
• Sustainability • Elimination of undue risk
• Health reform success
38

39. Value to health care professionals
Improve clinical decision-making
• Deliver information at the right place at the right time
• Promote prevention, screening and better disease management
• Help manage knowledge complexity and promote evidence-based medicine
• Provide enhanced diagnostic capabilities through digital imaging
Enhance efficiency
• Use appointment and scheduling systems to enhance workflow
• Improve nurses’ efficiency with clinical documentation
• Reduce need for filing, transcribing, phone calls photocopies
Facilitate communication
• Show electronic records and digital images to patients to facilitate understanding
• Communication across the care team and the continuum of care
39

40. Implications for physicians
Infoway does not:
• Purchase hardware/software for physician offices
• Offer consulting services to help acquire or implement office systems
But, Infoway does assist physicians by:
• Developing standards for IT (the architecture)
• Coordinating investment in the primary IT building blocks
• Collaborating on privacy/security issues
• Advancing an end-user acceptance strategy
» Encouraging jurisdictions to invest
» Working with physician organizations
» Physician advisory group
» Facilitating development of peer support networks
40

41. Facilitating change through clinician
e-Health support networks [CeHSN]
Establish strong, supported networks of EHR/EMR/EPR
peer leaders distributed across Canada to accelerate use
of electronic health record solutions through peer leader
support
Peer leaders include physicians, nurses and pharmacists
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42. Objectives of CeHSN
Support peers (physicians, pharmacists, nurses) in the use of
technology within their practice settings and by integrating it into
clinical work processes
Identify common and unique barriers and exchange advice on the
application of health care technology solutions
Share best practices and build new knowledge
Communicate stories that demonstrate accelerated uptake
within/between regional networks and professional groups
Collaborate with Infoway to enable an environment that accelerates
the adoption and integration of information technology toward
improving clinical care outcomes, access to information and
improved productivity
42

43. Lessons that are paying off
• Joint governance • Common procurement
• Joint planning • Common solutions
• Predictable funding • National pricing
• Common solutions • Shared services
architecture
• Knowledge sharing
• Common ICT standards
• Global leaders
• Accountable spend exporting expertise
A mid-term independent performance evaluation conducted
in 2005 and a 2006 review commissioned by Health Canada
both validated and supported Infoway’s value-added role.
43

44. On the road to 2015
44 44

45. Priorities to 2015 Largest investment required
1
Foundational Elements Finish what started in electronic health records and public
health surveillance
2
Implement electronic medical records in physician offices and
physician order entry systems in hospitals
3
Enable public visibility for wait times and access
Additional Elements
4
Facilitate patient self-care and empowerment
5
Trial and perfect more advanced functionality in wait times
and chronic disease management
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46. Challenges and
opportunities
46

47. Challenges to overcome
Physician office automation
Clinician adoption
Remote and first nations communities
Jurisdictional capacity
Standards
Interoperability and vendors
Patient engagement
Further capitalization
Public impatience
“If you think that an electronic health record is an essential backbone of
any modern health care system, then [2015 is] far too long to wait.”
Steven Lewis, Health Council of Canada, October 7, 2007
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48. The promise
• Increased patient
participation in care
• Well-managed chronic illness
• Improved access to care in
remote and rural communities
• Fewer adverse drug events
• Better prescribing practices
• Reduced wait times
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49. Thank you!
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