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eHealth:Contributing to health care quality, accessibility and productivity
Sarah Muttitt , Vice-President, Innovation and Adoption, Canada Health Infoway October 30 2007
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Each year, almost all of these records are hand-Each year, almost all of these records are hand-writtenwritten
• 100 million physician exam records100 million physician exam records
• 400 million prescriptions400 million prescriptions
• 500 million lab and radiology tests 500 million lab and radiology tests
The paper jungleThe paper jungleIn spite of spectacular advances in medicine, the foundation of health care delivery in Canada is still paper-based:
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Current challengesPREVENTIONPREVENTION DIAGNO
SISDIAGNOSIS
TREATMENT AND RECOVERYTREATMENT AND RECOVERY
Poor compliance with prevention guidelines
Poor compliance with prevention guidelines
Huge opportunity for errors, poor customer service, and repeat diagnostic tests
Huge opportunity for errors, poor customer service, and repeat diagnostic tests
Wrong decisions being made
Wrong decisions being made
• 37– 43% of Canadians recommended for influenza protection not vaccinated
• 30–40% of women at risk of cervical cancer not screened
• 37– 43% of Canadians recommended for influenza protection not vaccinated
• 30–40% of women at risk of cervical cancer not screened
• $15 billion worth of prescriptions are ordered by hand annually
• 1 billion service events scheduled manually
• 32 % of ER patients missing required information, leading to an average increased stay of 1.2 hours
• $15 billion worth of prescriptions are ordered by hand annually
• 1 billion service events scheduled manually
• 32 % of ER patients missing required information, leading to an average increased stay of 1.2 hours
• One in nine patients receive wrong medication or wrong dosage
• Up to 24,000 deaths each year result from preventable adverse events in hospitals, largely to incomplete information - more deaths than from breast cancer, motor vehicle accidents, and HIV combined
• One in nine patients receive wrong medication or wrong dosage
• Up to 24,000 deaths each year result from preventable adverse events in hospitals, largely to incomplete information - more deaths than from breast cancer, motor vehicle accidents, and HIV combined
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The need for health information The need for health information managementmanagement
Providers,
managers, patients,
public are
demanding more
IT has potential to
enable solutions to
address pressures
Care settings are shifting
Consumerism is growing
Pressures on resources are greater
Population is aging
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Where are we today?Where are we today?
According to an August 2007 study by the Conference
Board of Canada:• Fewer than one-in-four Canadian primary care doctors
use electronic medical records to keep track of
patients, the lowest of all countries in the OECD
In a 2006 Commonwealth Fund survey, Canada ranked
last:Country Physicians who use EMRs
Netherlands 98%
New Zealand 92%
United Kingdom 89%
Australia 79%
Canada 23%
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Annual IT spendingAnnual IT spendingPercentage of total budgets/revenuesPercentage of total budgets/revenues
Canada’s health care system is so huge it would rank No. 10 on the Fortune 500. It is more than three times the size of the country’s largest bank (compared to total revenue). Yet Canada under-invests in health care IT relative to other health care providers and information management industries. 2.9
3.4
4.0
4.54.7
5.4
Education
1.5 – 2.0
US HC provider
s
UK health care
Professional
services
US banking/ financial services
HC IT spend Canadian
jurisdictions
Calgary Regional Health
Authority
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Canada Health InfowayCanada Health Infoway• Created in 2001
• $1.6 billion in federal funding to date
• Independent, not-for-profit corporation
• Equally accountable to 14 federal/provincial/territorial governments
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.
Goal: By 2010, every province and territory and the populations they serve will benefit from new health information systems that will help modernize their health care system. Further, 50 per cent of Canadians will have their electronic health record readily available to their authorized professionals who provide their healthcare services.
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What is an EHR?What is an EHR?
An electronic health record (EHR) provides each individual in Canada with a secure and private lifetime record of their key health history and care within the healthcare system. The record is available electronically to authorized health care providers and the individual anywhere, anytime in support of high quality care.
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Access to detailed dataAccess to detailed dataResults and images Patient
informationMedical alerts
Medication history
Interactions
ImmunizationProblem list
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EHR: Overall benefits and valueEHR: Overall benefits and value
AccessAccess
• Reduced wait-times for diagnostic imaging services• Improved availability of community based health services• Reduced patient travel time and cost to access services• Increased patient participation in home care
QualityQuality
• Improved interpretation of diagnostic and laboratory results• Decreased adverse drug events• Decreased prescription errors• Increased speed and accuracy in detecting infectious
disease outbreaks
ProductivityProductivity
• Increased access to integrated patient information • Reduced duplicate tests and prescriptions• Reduced physician prescription call-backs• Reduced patient and provider travel costs
Capital cost: $10 billion – $12 billion
Benefits: $ 6 billion – $7 billion in savings annually
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March 2004 = $123 million 53 projects
Phase 2 Projects
Phase 0/1 Projects
System in placeJune 2007 = $1.203 billion 233 projects
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InfowayInfoway benefit evaluation benefit evaluation frameworkframeworkThe framework articulates the link between the systems in which Infoway invests and the resulting benefits, providing a basis for measurement.
UserSatisfaction
CompetencyUser SatisfactionEase of Use
UseUse Behavior/Pattern
Self Reported UseIntention to Use
NET BENEFITS
Quality•Patient safety•Appropriateness/ effectiveness•Health outcomes
Access•Ability of patients/providersto access services
•Patient and caregiverparticipation
Productivity•Efficiency•Care coordination•Net cost
Service quality
Responsiveness
Informationquality
ContentAvailability
System quality
FunctionalityPerformanceSecurity
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An expanding EHR circle? An expanding EHR circle?
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Infoway’s mandate is to increase the use of electronic
health records to improve the provision of patient care
As we move toward the next generation of health care, the envisioned health infostructures will enable data collection and potential sharing for secondary purposes
Whether it’s for health system management, quality improvement, population health or health research, there are huge benefits to be realized
The coming EHR world should streamline data collection, and improve the pervasive availability of data and the timeliness of the information
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DataWarehouse
JURISDICTIONAL INFOSTRUCTURE
POINT OF SERVICE
TerminologyRepository
Ancillary Data& Services
Registries Data& Services
EHR Data& Services
ImmunizationManagement
PHSReporting
SharedHealth Record
DrugInformation
DiagnosticImaging
Laboratory
Hospital, LTC,CCC, EPR
PhysicianOffice EMR
EHR Viewer
Physician/Provider
BusinessRules
EHRIndex
MessageStructures
NormalizationRules
Security MgmtData
Privacy Data Configuration
Physician/Provider
Physician/Provider
Lab System(LIS)
Lab Clinician
RadiologyCenter
PACS/RIS
Radiologist
PharmacySystem
Pharmacist
Public HealthServices
Public Health Provider
Longitudinal Record Services
HIALCommunication Bus
Common Services
ClientRegistry
ProviderRegistry
LocationRegistry
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HealthInformation
The EHR BlueprintThe EHR BlueprintData
Warehouse
HealthInformation
The EHR solutions based on the EHR Blueprint will have the features to allow other uses of clinically relevant data while protecting confidentiality of data and the privacy of patients and providers
The data warehouse is to facilitate the controlled disclosure of anonymized personal health information for secondary use and prevents trolling through the available data in the EHR
Relevant, reliable data, required for a given purpose, could be extracted from the EHR, anonymized at the point of extraction, and stored in one or more data warehouses where security is assured and audited
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Thank you
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