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

Thank You!

www.infoway-inforoute.cadgiokas@infoway-inforoute.ca