ITAC Health's Alberta e-Health Consultation Breakfast

Mark Brisson, Alberta Health and Wellness

October 20, 2009

Proposed Agenda for Presentation

• Alberta's Health System – Context• Provincial IM/IT Integrated Planning Focus

– Example: Personal Health Portal

• Key Business and IM/IT Priorities

Alberta’s Health System - Context

Current Challenges in Alberta’s Health SystemCurrent Challenges in Alberta’s Health System

• > 35% of provincial spending and growing

• Dependence on hospital and nursing home care, yet limited community capacity

• Close proximity and limited capacity of small hospitals

• Health provider supply and productivity

• Little coordination/integration across the health system

An Elderly Diabetic and their interactions with the Healthcare SystemAn Elderly Diabetic and their interactions with the Healthcare System

8

Acute Care

Legend:1. Annual flu shot2. Call HealthLink for advice3. HealthLink refers to GP4. Referral to Diabetes

Education Centre5. Referral to specialist6. Referral to Ophthalmologist7. Orders for diagnostics8. Admission to acute care9. Discharge medications10.Home dialysis11.Discharge care to GP12.In-Home Care

Client/Patient

2HealthLink

5

Internist/Endocrinologist

7

Diagnostic Services

Public Health (flu)

13

Family Phys

4

Diabetes EducationCentre

Ophthalmologist

6

11

9

Pharmacy

10

Home Dialysis

13

14 Home Care

12

Drivers of Demand and UtilizationDrivers of Demand and Utilization• Population growth and aging

– Patients over the age of 65 drive 45% of annual growth.

• Average utilization of Alberta’s large acute care hospitals is 90%

• Over half of small hospitals have utilization below 75%• Over 10% of all acute care beds are “blocked” by patients

waiting for long term care or supportive living• Chronic disease management

Health Spending - (2009-10)Health Spending - (2009-10)

• $12.9 billion

• $3 billion for physician services

• > $8 billion to Alberta Health Services (AHS)

• > $5 billion on staff salaries & benefits

• AHS spends $29.9 million per day

• If we continue at this rate of spending, AHS’s budget will grow by almost 200% by the year 2020

16 17 18 19 20

10,000

15,000

20,000

08 09 10 11 12 13 14 15

25,000

Projected former RHA spending 2008-2020, baseline and optimal cases $ billions

-6.2%

-6.3%

CONTROLLING COSTS WILL REQUIRE ALBERTA TO “BEND THE TREND”CONTROLLING COSTS WILL REQUIRE ALBERTA TO “BEND THE TREND”

Source: AHW Economics Unit; Health & Wellness 2008-11 Business Plan;

Year

Projection assuming historical growth - base

Projection assuming historical growth – optimistic scenario

AHW Projections – base scenario

AHW Projections – optimistic scenario

Where have we been…Where have we been…

• 120 hospital boards

• 17 regional health authorities

• 9 regional health authorities & 3 boards

• 1 centralized model: Alberta Health Services

Roles of AHW and AHSRoles of AHW and AHS

AHW• Strategic/directional policy

• Macrosystem design

• Performance measurement

• Monitoring, compliance and assurance

• Funding

• Capital recommendations and approvals to Treasury Board

AHS

• Service delivery

• Operational and workforce decisions

• Operational policies

• Allocation of funds to services

• Performance management

• Capital recommendations to AHW

Provincial IM/IT Integrated Planning Focus

Alberta “I-Plan” – 2009 - 2015Alberta “I-Plan” – 2009 - 2015

• An integrated IM/IT strategy that covers provincially-funded healthcare IM/IT investments 2009-2015

• Links overall business plans and strategies with detailed program/project plans

• Does set provincial strategic directions for healthcare IM/IT• Includes specific progress/benefit measures that can be tracked to

monitor execution of the Plan• To provide an accountability framework for monitoring progress in

executing the Plan.• Is currently being finalized, with Health Information Executive

Committee approval expected December 2009

I-Plan ScopeI-Plan Scope• Provincially-funded IM/IT initiatives undertaken by Alberta Health and

Wellness, Alberta Health Services, Provider groups, or other organizations in major healthcare domains:

– Point of service systems in hospitals and other healthcare delivery institutions (continuing care systems, public health systems);

– Reference systems, provincial repositories and other components comprising an EHR infrastructure (registries, portal, pHIE);

– Primary care and community medicine (e.g., EMRs);

– Performance management and reporting systems

I-Plan ContextI-Plan Context

Integrated I-Plan

Vision 2020 Strategic Guidance

Milestones, Metrics, benefits

EHR/NetCareStrategy

AHS IM/IT Strategy

POSP Plan Access/WTMStrategy

Pub HealthIT Strategy

EHR/NetCareProject Plans

AHS IM/IT Project plans

EMR Imp’n Plans

Access/WTMProject plans

Pub HealthProject plans

Operational / project plans

Organizational tactical & strategic plans

Personal HealthInfo Strategy

PHP ProjectPlans

InfrastructurePlans

Stakeholders Engaged in I-PlanStakeholders Engaged in I-Plan

• Alberta Health and Wellness Business and IM/IT Division• Alberta Health Services Clinical and IT Group• Primary Care Initiative• Physician Office System Program• Alberta Medical Association• College of Physicians and Surgeons of Alberta• Alberta College of Pharmacists• Alberta Continuing Care Association• Alberta Pharmacists’ Association• Primary Care Networks• Office of the Information and Privacy Commissioner • Canada Health Infoway

Provincial I-Plan Strategic DirectionsProvincial I-Plan Strategic Directions• Achieving universal access by providers to a complete

set of clinical data domains in the EHR • Accelerating implementation of interoperable EMRs and

other clinical management systems among independent providers

• Ensuring seamless flow of information across continuum of care

• Consolidation & standardization clinical business procedures, and supporting IM/IT

• Increasing personal access to health information

Example Initiative Description: Personal Health PortalExample Initiative Description: Personal Health Portal• DOMAIN DESCRIPTION:

• Personal Health Systems encompass all systems that grant patients access to clinical information. These systems allow patients to play an active role in partnering to manage their health and health care and provide them with information about themselves as well as the system in which they receive care. Patient portals are among the most common applications that can be used to fulfill this role and plans have already been developed to make his a reality in Alberta over the next 5 years.

• SCOPE STATEMENT:• The Personal Health Portal (PHP) is envisioned to be an innovative (web-based and

telephone service) application that will grant the public access to personalized information about wellness, health care, health conditions and treatments, health services, as well as many other health related aspects.

• TARGET STATE:• The PHP will enable diverse health system providers to supply health content and services

through the PHP framework, and assist in making the user experience as sea mless and coordinated as possible. Governance, standards, principles, and guidelines to support stakeholders in defining structures and content of the PHP will also be established.

• VALUE/BENEFITS (business language, not project-related)• The PHP will enable Albertans to have improved ability to proactively manage their health and

wellness, and access all health services that are available to them. • Patients and clinicians will have the improved ability to communicate and interact with one

another, and • Patients can more effectively participate in managing their treatment. • Patients will also be able to effectively engage the support of and assist others in their

treatment.

Benefits / Clinical ValueBenefits / Clinical Value

Benefits could be assessed based on potential savings in the following six categories:

1.Diabetes savings

2.Congestive Heart Failure (CHF) savings

3.Appointment Scheduling savings

4.E Visits savings

5.Medication Renewal savings

6.Pre-encounter Questionnaire savings

Key Business/Policy and IM/IT Priorities

Business / Policy Priorities Business / Policy Priorities

• Legislation to enable the delivery of health services using new models of care - MACH

• Building community capacity – Home Care, Aging in Place

• Creating a foundation of primary and public health

• Funding health providers for performance

• Implementing phase 2 of pharmaceutical strategy

• Proposing new approaches to funding health services

Key Project FocusesKey Project Focuses

AHW Primary• Provider Claims Reimbursement

• Pharmaceutical Information Network – e-Prescribing

• Performance Measurement / Data Warehousing / Health System Reporting

• Registry Integration and Development

• Health Workforce Forecasting

AHW/AHS/AMA, etc..Joint

• EHR (Portal/pHIE) Deployment / Capability Enhancements

• Personal Health Portal

• Identity and Access Management

• Integration w/ AHS/Community Systems

• Continued Physician Automation

• Public Health

• Continuing Care Technologies