FNIHB-First Nations eHealth Infostructure Program

First Nations Health Managers Conference

First Nations & Inuit Health Branch (FNIHB)Health Canada

September 2012

FNIHB Strategic Plan: Business Context

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First Nations Voices:

To achieve Better Health for First Nations in Canada the following is required:

• A First Nations controlled and sustainable health system; • A distinct yet interdependent and coordinated health system;• A full continuum of services;• A holistic approach to health;• A health system that protects and maintains the integrity of

traditional healing practices;• A system that enables the operationalization of OCAP

principles across the continuum of information

Health & Health Care Delivery Processes

Business Management &Corporate Services

• Manage Partner & Stakeholder Relationships

• Develop & Administer Programs & Services

• Manage Health Sector Infrastructure

Direct Patient (Primary/Community/Public Health Care)

• Deliver Health Services• Public Health Services

(Promotion, Protection, Injury Prevention, Emergency Preparedness)

• Manage Knowledge• Manage Partner & Stakeholder

Relationships

Program Planning, Management & Research• Develop & Administer

Programs & Services• Set Enterprise Direction &

Measure Performance

Direct Patient Care (Clinical) &

Public Health

Program Planning, Mgmt.

& Research

Business Mgmt.& Corporate

Services Population & Public Health• Deliver Population Level Services• Public Health Functions• Population Health Assessment &

Surveillance (Monitoring, Tracking,Measurement & Forecasting)

• Population Health Status Reporting

• Manage Knowledge• Manage Partner & Stakeholder

Relationships

Population &Public

FNIHB/First Nations: Data/Information Needs Context

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eHealth Infostructure: A Definition

An eHealth Infostructure (Information + Systems + Technology + People) modernizes, transforms & sustains health care to provide:

•optimal health services delivery (primary & community care included)

•optimal health surveillance

•effective health reporting, planning & decision making

•integration/compatibility with other health services delivery systems

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What is eHealth?: Foundation & eServices

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Community Infrastructure

Connectivity F/P Interoperability (iEHR) Technical StandardsSecurity Data Storage Technology

Governance & Management Framework

Sustainable Funding Accountability Framework Roles & ResponsibilitiesProcurement Performance Measurement Partnerships & StakeholdersProject, Program & Risk Management Privacy & Security OCAP

Change & Transition Management

Business Process Redesign In-Service Training Operational SupportEvaluation Community Capacity Building Technical SupportCommunity Engagement Streamline Processes Communications

Enable Community eServices

Public Health Surveillance (Panorama) eMail & Internet Drug Information SystemsProgram Reporting (eSDRT) EMRs,cEMRs,EHRs Diagnostic ImagingClient Registries Labs & Registries Telehealth/mHealth

Why?: Information Management & Rationale

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Population Health Health Data Holdings

Health Information Analysis & Reporting

Privacy Protection

Information for Community Managers Health Data Standards

Provider/Clinical Support Provincial Health Data Integration

Improved Community Access to:

Improved Quality: Improved Productivity:

Health Services Streamline Health Data eLearning & Case Management

Reduce Patient Travel Standardization of Health Data

Evidence Based Decision-Making

Health Education Patient Safety & Reduced Wait Times

Utilization of Best Practices

Public Health Surveillance (Panorama)

EHR Viewer & Client Registries

Telehealth/mHealth

Continuing Education & Training

Email, Internet & Portals

eReporting(Finance, Agreements,

Program)

EMR

The Future: eHealth Infostructure Fully Deployed

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First Nations Community Business Context

Schools

Water Treatment Centres

Businesses & Residences

Band Offices/EDO

Health Facilities

HC

Federal/Provincial Connectivity On-Reserve Strategy

Provincial, Private Infrastructure

Point of Presence(POP)

(AANDC/IndustryCanada)

Last Mile (5 – 100+)Community Connectivity

Point of Presence

(POP)

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Key Concepts/Definitions

Integration/alignment of Health Services: patient-centered form of integration resting on notions of continuity of care, the use of disease & case management, multi-disciplinary teamwork, seamless care delivery & the elimination of duplicate services & testing. An integrated health care system in which each jurisdiction provides First Nations seamless access to health services adapted to their unique & specific needs & accommodate First Nations with respect to service & structure.

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Key Concepts/Definitions

Technical Interoperability: referring to the ability of diverse systems & organizations to work together (inter-operate). Interoperability allows the iEHR to interconnect incompatible & disparate software or hardware systems to talk to each other, improving the ability to exchange information throughout the health system.

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Key Concepts/Definitions

Standards: enable the reliable exchange of information across disparate systems using common terminologies to describe, record & aggregate key clinical information. Standards support an integrated view of patient health information across providers & settings, leading to improved patient care & confidence. Standards form the foundation of interoperable systems.

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PROVINCIAL INFOSTRUCTURE

POINT OF SERVICE

Registries Data& Services

EHR Data& Services

Ancillary Data& Services

DataWarehouse

ImmunizationMgmt.

PHSReporting

HealthInformation

TelehealthService

Physician/Nurse/

Provider

BusinessRules

EHRIndex

MessageStructures

TerminologyRepository

NormalizationRules

Longitudinal Record Services

HIAL Communication Bus

Security MgmtData Privacy Data Configuration

ProviderRegistry

LocationRegistry

Common Services

EMRDatabase

ClientRegistry Shared

Health RecordDrug

InformationDiagnostic

Imaging Laboratory

Patient

Regional Interoperability: F/P/FN

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Health Infostructure Strategic Action Plan (HISAP)

FNIHB Strategic Goals (unfunded) :

1. An electronic health record capacity & capability for all First Nations people by 2020

2. Seamless integration of First Nations Infostructures with provincial electronic health record systems

3. Meaningful, standardized information for decision support available to First Nations, regions & FNIHB

4. Collaboration & sustainable partnerships between First Nations, Provinces & the Federal Government

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What We Do:

•Enable the greater use of information & communications technologies to increase access to health services, enhance productivity by health care professionals & improve patient outcomes.

•Support FNIHB and First Nations communities, as health care service providers, to better align its efforts with the emerging health information systems of the provinces & territories.

i.e. eHealth Program Guidelines & Health Infostructure Strategic Action Plan

Who We Are:

•7 Regional offices & 1 National Headquarters collaborate to deliver the program.

FNIHB eHealth Infostructure Program (eHIP)

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eHealth Priority Areas of Focus 2012-15

Branch eHealth Program Priorities• Program Governance, Program Guidelines, implement the HISAP• Panorama or other Provincial Public Health surveillance system• Broadband Connectivity• Telehealth (clinical, educational, administrative services)• Community IT Technical Support & Capacity Development, Network

Infrastructure & Equipment, Community Help Desk, Systems O&M

Emerging eHealth Activities/Trends in Regions/Communities• Electronic Medical Records (EMRs) & access to EHR Provincial viewer• Mustimuhw (Community Reporting System)• Client Registries• mHealth• eManagement of Contribution Agreements, eProgram Reporting tools

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FNIHB/FNs eHealth Infostructure Journey

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• Telehealth Research Projects

• FNIHIS

• Built Partnerships• Joint Governance &

Planning• Federal/FNs Engagement

(“What is eHealth?”)• FNs & Federal Capacity

Building• Increased Telehealth

Services (300 sites)• Broadband Connectivity• Panorama Planning• Begin EMRs/cEMR

• Panorama Deployment• EMR/EHR• mHealth• Client Registries• Fully Interoperable &

Integrated with Provinces• All Programs Using

Electronic Tools• eReporting (Program

Mgmt. & Accountability)

2000 20202010

Current & Future Activities

• Many of the projects & investments of the eHealth Infostructure Program have & continue to transform the way that health care services are delivered on-reserve.

• What follows is a partial list of regional activities currently underway as well as activities for possible development in the future:

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PharmacyCurrent:• Telepharmacy• Inventory Management • Decision Support & Drug Usage Analysis • ePharmacy Management Systems • EMR & EHR Integration

Future:• Drug Dispensing, Ordering & Inventory Systems• Linking to EMR/EHR’s (i.e. Monitoring Prescriptions, Quality Assurance, Audits)• Linking to Provincial Drug Information Systems (DIS)• Remote Dispensing• eLearning Tools

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Home & Community Care

Current:• Telehomecare & Consultations • Reporting Tools (i.e. eSRDT, CBRT, eHRT) • Direct Client Videoconferencing • Training & Education Tools (i.e. @YourSide Colleague, OneHealth)

Future:• Reference Tools & Applications• PDA/Tablet & mHealth Applications Use• Integration with EMR’s & EHR’s • “Store & forward” Solutions (i.e. images, clinical records)• Homecare-to-Hospital Videoconferencing (eLearning, Q&A’s)

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Current:• Community Education & Training • Dental Access Database • Business Software Applications • Teledental (Pre & Post Treatment) • Digital Imaging

Future:• “Store & Forward” Imaging & X-Rays• Business Intelligence Tools• Electronic Charts (Collection, Tracking & Reporting)• Tools Including Oral Cameras for Transmitting Images, Digital X-Ray Equipment• Linkage to EMRs

Dental

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Communicable Disease Control

Current:• FNIHIS & Integrated Public Health Information Systems (iPHIS) • eLearning Tools (Moodle, Elluminate, WebX, OneHealth Portal) • Immunization Registry & Monitoring • EMR Deployment

Future:• eLearning• Panorama Implementation• Integrating with AANDC’s Indian Registry• Integrating EMR’s & EHR’s with Provincial Systems• Development & Implementation of Surveillance Information Systems• Data Sharing Agreements

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Environmental Health

Current: • Environmental Health Information Systems • Watertrax Database • eLearning for Health Professionals

Future: • Improving Data Management Spatial Information• Mobile Solutions for Field Data Collection• eLearning for Environmental Health Officers• Web Based Information Sharing Sites/Portals• Enhanced Geographic Information Systems

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Clinical & Client Care

Current:• Clinical Telehealth Sites in First Nations Communities • eLearning & Telehealth Training • Remote Consultations & Therapy (Mental Health) • Teleopthamology & Digital X-Ray Imaging (Store & Forward)• Telerobotics

Future:• Upgraded Clinical Telehealth Rooms• Telerehabilitation• Telepharmacy• EMR Deployment & Integration• Remote Ultrasound Capability

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Mental Wellness

Current:• Substance Abuse Information System • Telepsychiatry, Televisitation & Telemental Health Services • Youth Suicide & Crisis Intervention Support • Addiction Services • Community Worker Education

Future:•Addiction Meetings by Telehealth/Videoconference•Provincially Integrated Electronic Medical/Health Records•Community Education Sessions through Telehealth, Videoconferencing, mHealth Technologies & Social Media

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Diabetes

Current:• Teleopthamology & Retinopathy • Surveillance & Reporting Tools (CBRT, Chronic Disease Surveillance Tool)

Future:• Integration Between Provincial Approved EMR’s & cEMR’s• Telehealth for Diabetes Case Management

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FNIHB/FNs: Elements to Align with Provinces

June 2012 Vancouver AFN/COACH: eHealth Convergence Forum

•Governance

•Sustainability

•Privacy & Data Sharing Issues

•Coordinate Policy & eHealth Strategies

•Leveraging Provincial & Infoway Investments for First Nations On-Reserve

•Quality Broadband, Network Access, Applications

First Nations eHealth Infostructure Program: A Policy Toolkit

1.1 eHealth Convergence Forum Report (AFN, COACH, Provincial CIOs, FNIHB-2012)1.2 AFN eHealth Strategy Framework (2012) 1.3 AFN eHealth Winnipeg Policy Forum (2010)1.4 AFN (All Chiefs) Policy Resolution eHealth (2012)1.5 FNIHB Health Infostructure Strategic Action Plan (HISAP) (2012)

2.1 eHIP Treasury Board Authority (2011)2.2 eHIP Guidelines (2012)2.3 eHealth Infrostructure Program Business Case & Scan

(2012)

3.1 eHIP Evaluation Phase 1 (2102), Phase 2 (2013)3.2 eHealth Future Evaluation Framework (2013-2018)3.3 FNIHB Lessons Learned Summary Report (2002-2012)

4.1 Community/Regional eHealth Readiness Assessment Models (2012)4.2 Regional First Nations’ & Partner eHealth Strategies, Scans & Plans

2.0 National eHealth Infostructure Program (eHIP)Directions

4.0 Regional Specific Directions

1.0 National Strategic Policy Directions

3.0 Evaluation & Lessons Learned (2006-2012)

BC Grand Chief Doug Kelly: “Listen, Learn and then Act”

First Nations Community eHealth Challenges

Requirements for the successful implementation of eHealth services & tools:

Engaged leadership & clear governance support; Building of trust relationships; Communicating with each jurisdictional partner a shared commitment to a common plan/goal; Health service delivery people understanding the value added & are trained to use the tools; Health organization partnerships with a data sharing mind set; Telecommunications/connectivity infrastructure; Flexible technology at the point of service, more mobile in nature & the technology support/

expertise where needed; Private sector, academia & NGO involvement & expertise; Updated Government health policy/regulations/laws & human capacity for the information age; Sustainable funding & advanced business approaches to maintain new eServices from a

project setting to the new way of doing business; Readiness to deal with political, technological, financial, organizational & human challenges.

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Questions?

Ernie Dal GrandeNational Manager,

eHealth Infostructure ProgramFNIHB, Health Canada