canadian perspective on an interoperable ehr medinfo september 8, 2004
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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 - PowerPoint PPT PresentationTRANSCRIPT
Canadian Perspective on anInteroperable EHR
MedinfoSeptember 8, 2004
Dennis GiokasChief Technology OfficerCanada 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
BCAB
SK
MB
ON
QC
NB
NS
NL
NUNT
YT
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
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
Client, Provider and Location RegistriesCross Program
Components
Innovation & Adoption
Drug Information
Systems
Laboratory Information Systems
Public Health
Systems Telehealth
Domain Repositories and
Healthcare Applications
Diagnostic Imaging
Systems
End user Adoption and Setting the Future Direction
Interoperable EHR
Infostructure
The Electronic Health Record
Architecture and Standards
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….
EHRS Solution (EHRS)
EHR Infostructure (EHRi)
RegistryServices
DomainRepository
Services
DomainRepository
Services
Communication BusCommunication BusCommunication BusCommunication Bus
Common Services
EHR Data & Services
Applications
ApplAppl ApplAppl ApplApplApplAppl
H
I A
L
EHR Repository
Services
EHR Repository
Services
20202002 2009
Pan-Canadian interoperable EHRPan-Canadian interoperable EHRImplementing EHR Building BlocksImplementing 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
Registries
Innovation & Adoption
Interoperable EHR
Infostructure
Applications
Registries
Innovation & Adoption
Interoperable EHR
Infostructure
Applications
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
Applications
Appl Appl ApplAppl
EHRS Solution (EHRS)
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
EHR Data & Services
EHR Repository
Services
DomainRepository
ServicesRegistryServices
Communication BusCommunication Bus
Common Services
H I
A L
Health Information Access Layer (HIAL) Standards, common and communications
services to integrate applications across the continuum of care and healthcare delivery jurisdictions
Enables integrated access and view Most cost effective approach to integration
Applications
Appl Appl ApplAppl
Applications Clinical data to share is “pushed” from
source systems into EHR in near real time
EHR data is “pulled” into the provider’s application for one integrated view
EHR Solution
EHRS EHRS EHRS EHRS EHRS EHRS EHRS
EHR Infostructure (EHRi)
RegistryServices
EHR Data & Services
DomainRepository
Services
Communication BusCommunication Bus
Common Services
H I
A L
EHR Repository
Services
Applications
Appl Appl ApplAppl
EHRS Solution (EHRS)EHR Infostructure (EHRi)
RegistryServices
EHR Data & Services
DomainRepository
Services
Communication BusCommunication Bus
Common Services
H I
A L
EHR Repository
Services
Applications
Appl Appl ApplAppl
EHRS Solution (EHRS)
Distributed, Message-based, Peer-to-Peer Network of EHRS Systems
Healthcare Provider’s View of EHR
EHR Solution (EHRS)
EHRClient
RegistryProviderRegistry
DomainRepository
(Lab)
DomainRepository(Pharmacy)
DomainRepository(Diagnostic
Imaging)
EMRDrug ProfilePatient History
Laboratory
Patient Info
Diagnostic Imaging
Communication BusCommunication Bus
Common Services
HIA
L
EHR Solution (EHRS)
EHREHRClient
RegistryClient
RegistryProviderRegistryProviderRegistry
DomainRepository
(Lab)
DomainRepository
(Lab)
DomainRepository(Pharmacy)
DomainRepository(Pharmacy)
DomainRepository(Diagnostic
Imaging)
DomainRepository(Diagnostic
Imaging)
EMRDrug ProfilePatient History
Laboratory
Patient Info
Diagnostic Imaging
Communication BusCommunication Bus
Common Services
HIA
L
Communication BusCommunication BusCommunication BusCommunication Bus
Common Services
HIA
L
Applications
Appl Appl
Results: Two Models Forming
Larger JurisdictionsProvincial Client and Provider Registries
Provincial Lab and Drug Repositories
Supra-regional EHR and DI Repositories
Local EMR, CIS and EHR viewer applications
Client Registry
ProviderRegistry
DI Repository
DrugRepository
Laboratory Repository
DI Repository
EHR
Communication BusCommunication BusCommon Services
HIA
L
Region 1 Region 2RE
GIO
NA
L\J
UR
ISD
ICT
ION
AL
LO
CA
L/R
EG
ION
AL
CIS
EHRViewer
EMR CIS
EHRViewer
EMR
Smaller JurisdictionsProvincial Client and Provider Registries
Provincial Lab, Drug, DI and EHR Repositories
Local EMR, CIS and EHR viewer applications
Client Registry
ProviderRegistry
DrugRepository
DI Repository
EHR
Communication BusCommunication BusCommon Services
HIA
L
RE
GIO
NA
L\
JUR
ISD
ICT
ION
AL
LO
CA
L
Laboratory Repository
CIS
EHRViewer
EMR CIS
EHRViewer
EMR
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
Investing in Project Deliverables that can be Replicated or Reused
Reuse drives down cost, accelerates timelines, reduces risk and enables interoperability.
Reuse drives down cost, accelerates timelines, reduces risk and enables interoperability.
Nosolution
Nosolution
Differentspecification
Differentspecification
DifferentstandardsDifferent
standardsSpecification
and standardsSpecification
and standardsData
modelData
modelBusinessprocess
Businessprocess
Businessrules
Businessrules
User Interface
User Interface
SamesolutionSame
solutionUse
shared serviceUse
shared service
Least leverageLeast leverage Most leverageMost leverage
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