# Presentation: 215445

## Canadian Perspective on anInteroperable EHRMedinfoSeptember 8, 2004 

**Dennis Giokas**
**Chief Technology Officer**
**Canada Health Infoway Inc.**

## Today’s Presentation

- The Canadian Healthcare System
- Introduction to Canada Health Infoway
- Investment Strategy and Approach
- Electronic Health Records Solution Architecture
- Early Benefits of Our Approach

## Overview of the Canadian Healthcare System

- Publicly financed health care system that supports over 31 million people
- Healthcare is delivered  by 14 federal, provincial and territorial Plans with Federal funding support
- The Plans are guided by 5 national principles set at the federal level
- Public Administration
- Comprehensiveness
- Universality
- Portability
- Accessibility

**PE**

**BC**

**AB**

**SK**

**MB**

**ON**

**QC**

**NB**

**NS**

**NL**

**NU**

**NT**

**YT**

**Notes:**
Since 1968, Canada has had a predominantly publicly financed health care system that supports 
31 million people
12.4 % over 65
20.4% rural
46.1% are dependents
Public Administration: Must be carried out on a non-profit basis by a public authority responsible to the provincial/territorial government 
Comprehensiveness: The health insurance plans of the provinces and territories must insure all medically necessary health services (insured services — hospital, physician, surgical-dental) 
Universality: All insured persons in the province or territory must be entitled to public health insurance coverage on uniform terms and conditions. 
Portability: Residents moving from one province or territory to another must continue to be covered for insured health services by the home province during a minimum waiting period. 
Accessibility: Reasonable access by insured persons to medically necessary hospital and physician services must be unimpeded by financial or other barriers, such as discrimination on the basis of age, health status or financial circumstances.

## Shared Accountability for Healthcare

**The Provinces/Territories**
- Plan, finance, manage, evaluate health services
- Provide public coverage for defined services (e.g. medical services, prescription drugs, dental care) for defined groups (seniors, children, welfare recipients)
**The Federal government**
- Fulfills defined health functions:
- Direct health service delivery to Veterans, native Canadians living on reserves, Military personnel, inmates of federal penitentiaries, and the Royal Canadian Mounted Police
- Health protection, disease prevention, health promotion services
- Funds are transferred from the federal government to provinces by direct block transfer based on funding formulas

**Notes:**
Five important principles are embodied in the Act
Public Administration: Must be carried out on a non-profit basis by a public authority responsible to the provincial/territorial government 
Comprehensiveness: The health insurance plans of the provinces and territories must insure all medically necessary health services (insured services — hospital, physician, surgical-dental) 
Universality: All insured persons in the province or territory must be entitled to public health insurance coverage on uniform terms and conditions. 
Portability: Residents moving from one province or territory to another must continue to be covered for insured health services by the home province during a minimum waiting period. 
Accessibility: Reasonable access by insured persons to medically necessary hospital and physician services must be unimpeded by financial or other barriers, such as discrimination on the basis of age, health status or financial circumstances.

## Recognizing the Need for EHRs

- Late 1990s
- Growing F/P/T consensus on the need for interoperable electronic health record systems via Canada Health Infoway Report and pan-Canadian Health Infostructure Tactical Plan
- September 2000
- Canada’s First Ministers unanimously agree “to work together to strengthen a Canada-wide health infostructure.”
- Canada Health Infoway launched in late 2000
- Independent, not-for-profit corporation equally accountable to 14 F/P/T governments
- $1.2B Capitalization since inception
- $500M - Electronic Health Records focus (initial funding)
- $600M - Accelerated EHR and Telehealth (March 2003)
- $100M - Health Surveillance Systems (March 2004)

## Infoway’s Mandate

**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. To build on existing initiatives and pursue collaborative relationships in pursuit of its mission.
**Goal**** **
- Infoway’s plan is to have an interoperable EHR in place across 50 percent of Canada by the end of 2009.
**Core Business**
- We invest with public sector partners to develop, replicate and re-use compatible electronic health systems, thereby leveraging public funds, knowledge and results across Canada, to build a safer, more efficient healthcare system.

## Infoway’s Investment Strategies

- Targeted Programs
- Focused on nine Investment Programs
- Leveraged Investment
- Invest in solutions that can be replicated in jurisdictions across the country
- Collaboration with the Public Sector
- Joint planning with health ministries and other partners
- Joint Investments
- Share the investment in projects with our public sector partners
- Focus on End-Users
- Early and on-going focus on end-users to gain acceptance and adoption
- Alliances with the Private Sector
- Form strategic alliances with private sector to implement standards-based, commercial solutions that reduce cost and risk
- Measure Benefits and Adjust
- Continually measure the benefits achieved against those planned and make the necessary adjustments

## Nine Strategic Investment Programs

**Nine Strategic Investment Programs**

**- $60m**

**$185m**

**$150m**

**$100m**

**$150m**

**$220m**

**- $175m**

**- $25m**

**- $110m**

**Notes:  (1) Includes investments to support project management, user-adoption, change management,  ****knowledge transfer, standards and benefits evaluation, representing 30% of program investments**
**             ****(2) Will also require Jurisdictional Investment of $0.6-0.8B**

## Getting there over time....

**2020**

**2002**

**2009**

**Pan-Canadian interoperable EHR**

**Implementing EHR Building Blocks**

- Five Application Areas
- Interoperable EHR using common Presentation Layer & key Blueprint Elements
- Target 50% of Canada’s population

**2009 Target/Focus**

- All Application Areas incorporating full “mentoring “ technology
- Interoperable EHR based on the fully standardized EHRS Blueprint Architecture
- Target 100% of Canada’s population

**2020 Target/Focus**

**Conceptual EHRS Blueprint**

- Getting there requires stepped  improvement in applications developed, technology evolution, geographic coverage, standards coverage

## Results to Date – Investments* 

**63** ongoing and completed projects in **10**** **jurisdictions
**$135** million in approved investments
- Additional **$200** million earmarked for specific projects but not yet signed

**** As of June 30, 2004****** ***

## Summary of Key EHRS Architecture Concepts

**Summary of Key EHRS Architecture Concepts**

- EHR
- Patient-centric, womb to tomb
- All clinically relevant data that needs to be shared
- Encounter information
- Structured, integrated and semantically consistent
- Registries to identify people, providers and locations of care

**Notes:**
How does data get into the EHR?
Data is pushed or published into EHR
From source systems

Viewing data in the EHR
Generally from the applications the providers use in their daily context
E.g. primary care doctor EPR applications have means to view and navigate the EHR
Emergency room doctor from the hospital CDR and EHR

## EHR Solution

**Distributed, Message-based, Peer-to-Peer Network of EHRS Systems**

**Notes:**
Distributed, Message-based, Peer-to-Peer Network of EHRS Systems

## Healthcare Provider’s View of EHR

## Results: Two Models Forming

## Standards Development Principles

- Standards development will be done with the interests of *Infoway’s* Members first and foremost
- Driven by the benefits evaluation of our investments
*Infoway* will drive standards which are needed for the investment programs defined in the business plan
- Standards efforts will follow the “influence, adopt, adapt, create” approach
*Infoway* funding for Standards work will be in the context of projects
- Interoperability profiles define the integration architecture of the interoperable EHR with clinical systems

## A Strong Focus on Re-Use & Interoperability

## Early Benefits of Collaborative Development

**Aligning Strategies and Investments**
- Infoway and jurisdictions are well underway in aligning their strategies and investments toward implementing an interoperable electronic health record across 50% of Canada by the end of 2009
**Leveraging Investments**
- Jurisdictions have leveraged their investment dollars with Infoway’s
**Replication and Re-use**
- Replication of client registry and provider registry solutions, as well as the DI shared-services model is driving economies of scale, cost-savings and accelerated deployment
- Cost avoidance and knowledge transfer across jurisdictions through “How-to-Toolkits” enable faster project start-up
**Benefiting from National Procurement Agreements **
- Provide favourable terms for the procurement of proven solutions
**Implementing Standards-Based Solutions**
- Adopt, adapt or develop pan-Canadian standards
- Increases interoperability & choice, while lowering overall cost

## Summary

- EHR systems are seen as key to a **safer, cost-effective healthcare **network
- Interoperable EHRs in place across **50 percent of Canada by end of 2009**
**Tangible value** **is being delivered** as we proceed, focused on
- Registries
- Diagnostic Imaging Systems
- Drug Information Systems
- Laboratory Information Systems
- Telehealth
- Public Health Surveillance
- Interoperable Electronic Health Record
- EHR securely **integrates data** from varied clinical information systems
**Privacy** is addressed in** **everything** **we do
- Healthcare community **support and adoption are key** to our success

## Thank You!

- _[www.infoway-inforoute.ca](http://www.infoway-inforoute.ca/)_
***dgiokas@infoway-inforoute.ca***