Building Bridges Canada’s eHealth Initiative

Trevor Hodge, Senior Vice President, Canada Health InfowaySeptember 30, 2010

Saskatoon 2010

2

Agenda

• Background

• Vision 2015

• Infoway’s Investment Approach

• Our Investments: • Electronic Health Record

• EMR & Integration

• Telehealth,

• Consumer Health and

• Public Health Surveillance

• Public Education

3

National eHealth Initiatives17

National EHR 21

Emerging EHR Positioning to Emerge 23

Australia, Canada, Denmark, Finland, Hong Kong, Israel, Netherlands, New Zealand, Norway, Saudi Arabia, Singapore, Spain,

Sweden, Taiwan, UAE, U.K., U.S.A.

Argentina, Austria, Belgium, Belize, Brazil, Czech Republic, Estonia, France, Germany, Iceland, Ireland,

Italy, Japan, Lithuania, Luxembourg, Malaysia, Mexico, Slovakia, South Korea, Switzerland, Turkey

Abu Dhabi, Bangladesh, Bulgaria, China, Columbia, Costa Rica, Croatia, Cyprus,

Ecuador, Egypt, Greece, Hungary, India, Indonesia, Malta, Poland, Portugal, Puerto

Rico, Qatar, Slovenia, South Africa, Thailand, The Philippines

44

Canada Health Infoway

• Created in 2001 as an independent not-for-profit corporation

• Accountable to 14 federal/provincial/territorial governments

• $2.1 billion in federal funding to date - $500 million in March 2010 as part of the Economic Action Plan

• Matching jurisdiction contributions account for 25 percent of eligible projects costs, plus on-going operations and maintenance

Leadership

• National leadership, expertise and services to support the jurisdictions in their eHealth implementations

• EHR Architectural Blueprint

• pan-Canadian Standards

Strategic Investor

• Co-invest with jurisdiction and private sector partners

• Involved in project planning, risk management, deliverable quality and benefits realization

• Gated funding approach

5

The Vision

A high quality, sustainable and effective Canadian health care system supported by an infostructure that provides residents of Canada and their health care providers timely, appropriate and secure access to the right information when and where they enter into the health care system. Respect for privacy is fundamental to this vision.

6

Common DirectionVision 2015During 2006, Canada identified five health information and technology priorities for the next 10 years, namely

Implement electronic medical records in physician offices and physician order entry systems in hospitalsImplement electronic medical records in physician offices and physician order entry systems in hospitals

Deploy Wait Time Management SolutionsDeploy Wait Time Management Solutions

Implement Consumer Health Solutions to support selfcareImplement Consumer Health Solutions to support selfcare

Integrate Chronic Disease Management Solutions, starting with diabetesIntegrate Chronic Disease Management Solutions, starting with diabetes

Finish what we have started in electronic health records, telehealth and public health surveillanceFinish what we have started in electronic health records, telehealth and public health surveillance

Foundati

onal Ele

ments

Ad

dit

ional E

lem

ents

33

44

55

22

11

7

Vision 2015Business Goals

• Access – support consistent access to patient care• Availability of services; Ability to access services; Consumer participation

• Quality – provide safer and improved quality of patient care• Safety, Appropriateness and effectiveness; Health outcomes

• Productivity – more efficient use of health system resources• Efficiency; Care Coordination; Net cost

The Business Case

• Cost – $10 B to $12 B capital cost; $1.5 B to $1.7 B annual operating cost

• Benefits – $6 B to $7 B annually

8

Vision 2015The Return on InvestmentOf the ~$6.0 billion annually (in 2007 dollars)

Source: Defining a path forward for Canada’s health infostructure – Final Report (McKinsey).

$5.2B benefit (86%)

Cost Avoidance &Capacity Creation

• Cost Avoidance/Capacity benefits => reduction in medication errors and adverse drug events; improvements in radiology productivity

• Cost Reduction benefits => and reductions in laboratory and diagnostic imaging tests and diagnostic imaging film/space costs

AccesAccesss

QualityQuality ProductivityProductivity

$0.8B benefit (14%)

Cost Reduction

9Source: Defining a path forward for Canada’s health infostructure – Final Report (McKinsey).

Vision 2015The Return on InvestmentOf the ~$6.0 billion annually

Current Scope

Outlook to 2015

DrugLab

DI69%27%

Drug

50%

12%

DILabCDM

Wait Times

Self Care

10

• ~ $2.1 B in 12 investment programs • Co-invest with jurisdictions, • 76% of funds approved and 45% expensed as at April 2010

Infoway Investments

60%

30%

11

Integrating Points of CareHomecare

Emergency Services

Pharmacy

Laboratory

DiagnosticHospital Emergency

Specialist Clinic

Community Care Centre

Clinic

12

Building Bridges

13

Electronic Health Records~$1.3 B investment

14

Electronic Health RecordsClinical Value

Infoway Focus• Clinical use has been the primary focus rather than administrative

use (e.g. billing) or secondary use (e.g. research and evaluation)

Clinical Value • Put/Get patient and provider demographics• Put/Get laboratory results, both as provider ordered results and a

complete laboratory results profile • Put/Get prescriptions/renewals and a complete medication profile,

including clinical decision support (e.g. drug-drug interactions)• Put/Get diagnostic imaging reports and images, both as provider

ordered results and a complete diagnostic imaging profile• Put/Get immunization profile• Put/Get clinical reports (e.g. discharge summaries)

15

• structured data (e.g. lab, drug)• clinical documents• e-prescribing• clinical decision support (i.e. DUR)• consumer health• health information exchange/sharing• privacy and security

• diagnostic imaging• telehealth• public health

• hCPOE• reporting

Electronic Health RecordsUSA Meaningful Use

16

End-user Applications

ITunes

Music (data)

eCommerce Platform

End-UserDevices

Technology Approach Used Today

Data, Applications and Services

17

End-user Applications

Electronic Health Record

Electronic Medical Record

Hospital Info. System etc

eHealth Platform

End-UserDevices

Health DataApplications & Services

Technology Approach Used Today

18

• Common architecture accepted by jurisdictions and vendors

• links local clinical systems with jurisdiction and regional registries and repositories using a data sharing approach

• serves as a reference model for Infoway investments

• Freely available on the Infoway website

http://www.infoway-inforoute.ca

Infoway Investment Approach

19

JURISDICTIONAL INFOSTRUCTURE

POINT OF SERVICE

Registries Data& Services

EHR Data& Services

LaboratoryDrug

InformationDiagnosticImaging

Shared Health Record

Hospital, LTC,CCC, EPR

PhysicianOffice EMR

EHR Viewer

Physician/Provider

Physician/Provider

Physician/Provider

Lab System(LIS)

Lab Clinician

RadiologyCenter

PACS/RIS

Radiologist

PharmacySystem

Pharmacist

Public HealthServices

Public Health Provider

Longitudinal Record Services

HIALCommunication Bus

Common Services

ClientRegistry

ProviderRegistry

Patient Portal

Public

The End-State Blueprint

20

Electronic Health Records

21

Progress at March 31, 2010 to 2010 Goal = 22%

Forecasted progress to December 31, 2010 Goal = 42% (as at August 2010)

Electronic Health RecordsForecasted Progress to 2010 Goal

22

Alberta Netcare – electronic health record

• Demographic, diagnostic imaging, drug, laboratory and hospital data

Users• Over 25,000 active users of the electronic health record

• 40% of users are physicians (23%) and their office support staff (17%)

• 28% of users are nurses

Use • Lab results and transcribed reports• Medication profiles

23

Electronic Medical Records and Integration$340M investment

(additional $40M for Adoption and Support)

24

Electronic Medical Records

• Use is slowly increasing – 37% in 2009, up from 23% in 2006 and 14% in 2000

• However, still a major gap – a critical part of the architecture that is still at low levels of adoption and use in Canada

• Progress in some jurisdictions – BC, AB, SK, MB, ON and NS have EMR implementation programs in place

Source: 2009 Commonwealth Fund International Health Policy Survey of Primary Care Physicians.

99 97 97 96 95 94 94

72 68

4637

0

25

50

75

100

NET NZ NOR UK AUS ITA SWE GER FR US CAN

Physician Use of Electronic Medical RecordsPercent

25

EMR and Clinical Systems IntegrationThe Investment Focus

Upgradeexisting clinical solutions

• Electronic medical records

• Community pharmacy systems

• Connect hospital information systems

Deploy more clinical solutions

Implement upgraded electronic medical

records in community and ambulatory

settings

Achieveincreased clinical value

Derive clinical value from the use of

electronic medical records in community

care settings

~35% ~65%

2626

EMR & Integration Investment Approach

“Deploy and Achieve” targets jurisdictions • Bolster existing jurisdiction physician office system programs that fund

physicians to implement an approved EMR system

• Accelerate the establishment of physician office system programs in jurisdictions without one

• Invest in adoption support (e.g. peer-to-peer networks) activities both locally and nationally

“Upgrade” targets jurisdictions and vendors• Invest with EMR vendors primarily to upgrade their solutions to an

agreed-upon integration specification based on pan-Canadian standards

• Jurisdictions are funded to deploy the upgraded EMR solutions; as well, Infoway will invest directly with jurisdictions to integrate EMR, hospital, and community pharmacy with their available EHR infostructure

27

• Tailor the program to address the readiness of each jurisdiction; their approved vendors and the timing of their EMR upgrade process

• Primary Users are physicians, both general practitioners and specialists (~50,000); Nurse Practitioners (~1,000); in physician offices, ambulatory (outpatient) clinics and health centres

• Invest in EMRs for a target population of up to 12,000 eligible clinicians in community settings and up to 8,000 eligible concurrent users (seats) in ambulatory care settings

• Co-invest with jurisdictions for a set fee of up to 50% of their cost to a ceiling based on the type of care setting

EMR & Integration Investment Approach

28

Infoway Focus• Increased clinical value and not administrative use (e.g. billing)• Increased clinical value is validated to ensure it is occurring

Infoway Clinical Value Criteria Level 1• Enter encounter notes• Enter problem lists, allergies, immunizations and vitals• Enter new prescriptions/renewals into EMR, which can be printed• Generate automated alerts and reminders from within EMR• Receive laboratory results into the EMR

Infoway Clinical Value Criteria Level 2• Clinician does e-prescribing and receives a complete medication

history and automated medication alerts into the EMR

Electronic Medical RecordsAchieving Clinical Value

29

Telehealth$110 M investment

30

Remote Monitoring

Telehealth Device Deployment• The deployment of telehealth devices varies across Canada

Teletriage and video-conferencing technologies are mature, while remote monitoring and pathology data rich image devices are emerging in their deployment

TeletriageService Deployment

Teletriage 11 of 13 jurisdictions are enabled with 24/7 telephone triage services.

Video-Conferencing All Canadian jurisdictions offer established video-conferencing services to facilitate patient care between providers.

Remote Monitoring Currently, 8 of 13 Canadian jurisdictions offer localized and emerging remote patient monitoring services with New Brunswick the only jurisdiction to offer a province-wide remote patient monitoring service for patients.

Data Rich Image Transfer While teleradiology services are available in all jurisdictions, only 1 is equipped with widespread telepathology and another 5 are emerging

31

Ontario Telemedicine Network

Profile• One of the largest telemedicine networks in

the world using live, two-way videoconferencing systems and related diagnostic equipment.

• Rapidly moving into remote monitoring and telepathology

• Over 3,000 health care professionals delivering care

• Services provided via 925 sites across the province

• In 2009, over 90,000 patient visits in Ontario were conducted using telemedicine

• Significant integration with First Nations communities

32

Telehealth Deployment in Aboriginal Communities

• Through a mix of federal, jurisdiction and Infoway support, the majority of Canada’s first nation communities are telehealth-enabled.

• The focus is aboriginal communities with health centres

• Infoway will meet its target of 215 communities by December 31, 2010 and exceed that target into 2011.

Independent federal & jurisdiction investment

33

Consumer Health Solutions$45 M investment

34

Patient Portal Functionality• Find health information A-Z• Find provider, facility and service information• Communicate with healthcare providers• View health record• Manage medication refills• View wait times• Book appointments with family physicians• View who has looked at your health record

Patient Portal Integration• Physician offices• Community pharmacies• Hospitals• Private sector offerings

Consumer Health

35

Public Health Surveillance$150 M investment

36

Public Health Surveillance - Panorama

• Panorama solution has been built which is fully interoperable with the EHR infostructure

• Functionality− Vaccine− Immunization− Investigations− Outbreak− Alerting− Reporting

• Implementation phase− Quebec− British Columbia− Ontario− Nova Scotia− Newfoundland-Labrador− Saskatchewan− Manitoba

37

Public Education Campaign

While the campaign aims to inform the opinions of all Canadians, the focus will be on those who are most likely to see the benefits of EHR systems:

Patients living with chronic conditions – long-term, frequent users of the system

Family Caregivers – women aged 40+ with children and are responsible for the health of their family

Seniors – men or women aged 55+ who are facing health care challenges; frequent users of the system and who are interested in health policies

38

Campaign components

The campaign will use TV, print, online and news media outreach, as well as an informational microsite, to inform Canadians about the benefits of EHR systems

TV Print Knowingisbetter.ca

Online Banners

Knowing is Better than Not Knowing

39

Some Final Thoughts – on Building Bridges

• Building Bridges … to think through healthcare and information technology as a country and not just as 14 individual healthcare systems

• Building Bridges … to reach a common understanding of what information needs to be exchanged across care settings (the continuum of care) so we can achieve improved clinical value

• Building Bridges … to those clinician communities who have been relatively slow to adopt technology

• Building Bridges … to elected officials across Canada to obtain their continual commitment and support for a 10-15 year journey

• Building Bridges … to the public to ensure so they understand what we are doing and the benefits that they will receive

Thank you