Transcript Hodge - ACCADA Presentation

Building Bridges
Canada’s eHealth Initiative
Saskatoon 2010
September 30, 2010
Trevor Hodge, Senior Vice President, Canada Health Infoway
Agenda
• Background
• Vision 2015
• Infoway’s Investment Approach
• Our Investments:
• Electronic Health Record
• EMR & Integration
• Telehealth,
• Consumer Health and
• Public Health Surveillance
• Public Education
2
National eHealth Initiatives
National EHR
17
Australia, Canada, Denmark, Finland, Hong Kong,
Israel, Netherlands, New Zealand, Norway, Saudi
Arabia, Singapore, Spain, Sweden, Taiwan, UAE,
U.K., U.S.A.
Emerging EHR
21
Argentina, Austria, Belgium, Belize, Brazil, Czech Republic,
Estonia, France, Germany, Iceland, Ireland, Italy, Japan,
Lithuania, Luxembourg, Malaysia, Mexico, Slovakia, South
Korea, Switzerland, Turkey
Positioning to Emerge
23
Abu Dhabi, Bangladesh, Bulgaria, China, Columbia,
Costa Rica, Croatia, Cyprus, Ecuador, Egypt,
Greece, Hungary, India, Indonesia, Malta, Poland,
Portugal, Puerto Rico, Qatar, Slovenia, South
Africa, Thailand, The Philippines
3
Canada Health Infoway
• Created in 2001 as an independent not-for-profit corporation
• Accountable to 14 federal/provincial/territorial governments
• $2.1 billion in federal funding to date - $500 million in March 2010
as part of the Economic Action Plan
• Matching jurisdiction contributions account for 25 percent of
eligible projects costs, plus on-going operations and maintenance
Leadership
• National leadership, expertise
and services to support the
jurisdictions in their eHealth
implementations
Strategic Investor
• Co-invest with jurisdiction and
private sector partners
• EHR Architectural Blueprint
• Involved in project planning,
risk management, deliverable
quality and benefits realization
• pan-Canadian Standards
• Gated funding approach
44
The Vision
A high quality, sustainable and effective Canadian health
care system supported by an infostructure that provides
residents of Canada and their health care providers timely,
appropriate and secure access to the right information
when and where they enter into the health care system.
Respect for privacy is fundamental to this vision.
5
Common Direction
Vision 2015
Foundational Elements
During 2006, Canada identified five health information and
technology priorities for the next 10 years, namely
1
Finish what we have started in electronic health records,
telehealth and public health surveillance
2
Implement electronic medical records in physician offices and
physician order entry systems in hospitals
Additional Elements
3
Deploy Wait Time Management Solutions
4
Implement Consumer Health Solutions to support selfcare
5
Integrate Chronic Disease Management Solutions, starting with
diabetes
6
Vision 2015
Business Goals
• Access – support consistent access to patient care
•
Availability of services; Ability to access services; Consumer
participation
• Quality – provide safer and improved quality of patient care
•
Safety, Appropriateness and effectiveness; Health outcomes
• Productivity – more efficient use of health system resources
•
Efficiency; Care Coordination; Net cost
The Business Case
• Cost – $10 B to $12 B capital cost; $1.5 B to $1.7 B annual
operating cost
• Benefits – $6 B to $7 B annually
7
Vision 2015
The Return on Investment
Of the ~$6.0 billion annually
(in 2007 dollars)
Cost Avoidance &
Capacity Creation
Cost Reduction
$5.2B benefit (86%)
$0.8B benefit (14%)
Quality
Access
Productivity
• Cost Avoidance/Capacity benefits => reduction in medication
errors and adverse drug events; improvements in radiology
productivity
• Cost Reduction benefits => and reductions in laboratory and
diagnostic imaging tests and diagnostic imaging film/space costs
Source: Defining a path forward for Canada’s health infostructure – Final Report (McKinsey).
8
Vision 2015
The Return on Investment
Of the ~$6.0 billion annually
Lab
27%
Drug
69%
DI
Drug
Self Care
Current Scope
50%
Wait
Times
12%
CDM
Lab
DI
Outlook to 2015
Source: Defining a path forward for Canada’s health infostructure – Final Report (McKinsey).
9
Infoway Investments
• ~ $2.1 B in 12 investment programs
• Co-invest with jurisdictions,
• 76% of funds approved and 45% expensed as at April 2010
30%
60%
10
Integrating Points of Care
Homecare
Clinic
Emergency
Services
Community
Care Centre
Pharmacy
Laboratory
Specialist
Clinic
Hospital
Emergency
Diagnostic
11
Building Bridges
12
Electronic Health Records
~$1.3 B investment
13
Electronic Health Records
Clinical Value
Infoway Focus
• Clinical use has been the primary focus rather than administrative
use (e.g. billing) or secondary use (e.g. research and evaluation)
Clinical Value
• Put/Get patient and provider demographics
• Put/Get laboratory results, both as provider ordered results and a
complete laboratory results profile
• Put/Get prescriptions/renewals and a complete medication profile,
including clinical decision support (e.g. drug-drug interactions)
• Put/Get diagnostic imaging reports and images, both as provider
ordered results and a complete diagnostic imaging profile
• Put/Get immunization profile
• Put/Get clinical reports (e.g. discharge summaries)
14
Electronic Health Records
USA Meaningful Use
• hCPOE
• reporting
•
•
•
•
•
•
•
• diagnostic imaging
• telehealth
• public health
structured data (e.g. lab, drug)
clinical documents
e-prescribing
clinical decision support (i.e. DUR)
consumer health
health information exchange/sharing
privacy and security
15
Technology Approach Used Today
eCommerce Platform
ITunes
Music (data)
Data, Applications
and Services
End-user Applications
EndUser
Devices
16
Technology Approach Used Today
eHealth Platform
Health Data
Applications & Services
Electronic Health Record
Electronic Medical Record
Hospital Info. System etc
End-user Applications
EndUser
Devices
17
Infoway Investment Approach
• Common architecture
accepted by jurisdictions
and vendors
• links local clinical systems
with jurisdiction and
regional registries and
repositories using a data
sharing approach
• serves as a reference
model for Infoway
investments
• Freely available on the
Infoway website
http://www.infoway-inforoute.ca
18
The End-State Blueprint
JURISDICTIONAL INFOSTRUCTURE
EHR Data
& Services
Registries Data
& Services
Client
Registry
Laboratory
Drug
Information
Diagnostic
Imaging
Shared Health
Record
Provider
Registry
Longitudinal Record Services
Common Services
HIAL
Public Health
Services
Communication Bus
Pharmacy
System
Public Health
Provider
POINT OF SERVICE
Pharmacist
Radiology
Center
PACS/RIS
Radiologist
Lab System
(LIS)
Lab
Clinician
Hospital, LTC,
CCC, EPR
Physician/
Provider
Physician
Office EMR
Physician/
Provider
EHR Viewer
Physician/
Provider
Patient
Portal
Public
19
Electronic Health Records
20
Electronic Health Records
Forecasted Progress to 2010 Goal
Progress at March 31, 2010 to 2010 Goal = 22%
Forecasted progress to December 31, 2010 Goal = 42%
(as at August 2010)
21
Alberta Netcare – electronic health record
• Demographic, diagnostic imaging, drug, laboratory and
hospital data
Users
• Over 25,000 active users of the electronic health record
• 40% of users are physicians (23%) and their office support
staff (17%)
• 28% of users are nurses
Use
• Lab results and transcribed reports
• Medication profiles
22
Electronic Medical Records and Integration
$340M investment
(additional $40M for Adoption and Support)
23
Electronic Medical Records
•
•
•
Use is slowly increasing – 37% in 2009, up from 23% in 2006 and
14% in 2000
However, still a major gap – a critical part of the architecture that is
still at low levels of adoption and use in Canada
Progress in some jurisdictions – BC, AB, SK, MB, ON and NS have
EMR implementation programs in place
Physician Use of Electronic Medical Records
Percent
100
99
97
97
96
95
94
94
72
75
68
46
50
37
25
0
NET
NZ
NOR
UK
AUS ITA SWE GER
FR
US
Source: 2009 Commonwealth Fund International Health Policy Survey of Primary Care Physicians.
CAN
24
EMR and Clinical Systems Integration
The Investment Focus
Upgrade
existing clinical solutions
• Electronic medical
records
• Community pharmacy
systems
• Connect hospital
information systems
~35%
Deploy
Achieve
more clinical solutions
increased clinical value
Implement upgraded
electronic medical
records in community
and ambulatory
settings
Derive clinical value
from the use of
electronic medical
records in community
care settings
~65%
25
EMR & Integration Investment Approach
“Deploy and Achieve” targets jurisdictions
• Bolster existing jurisdiction physician office system programs that
fund physicians to implement an approved EMR system
• Accelerate the establishment of physician office system programs in
jurisdictions without one
• Invest in adoption support (e.g. peer-to-peer networks) activities both
locally and nationally
“Upgrade” targets jurisdictions and vendors
• Invest with EMR vendors primarily to upgrade their solutions to an
agreed-upon integration specification based on pan-Canadian
standards
• Jurisdictions are funded to deploy the upgraded EMR solutions; as
well, Infoway will invest directly with jurisdictions to integrate EMR,
hospital, and community pharmacy with their available EHR
infostructure
26
26
EMR & Integration Investment Approach
•
Tailor the program to address the readiness of each jurisdiction;
their approved vendors and the timing of their EMR upgrade
process
•
Primary Users are physicians, both general practitioners and
specialists (~50,000); Nurse Practitioners (~1,000); in physician
offices, ambulatory (outpatient) clinics and health centres
•
Invest in EMRs for a target population of up to 12,000 eligible
clinicians in community settings and up to 8,000 eligible
concurrent users (seats) in ambulatory care settings
•
Co-invest with jurisdictions for a set fee of up to 50% of their
cost to a ceiling based on the type of care setting
27
Electronic Medical Records
Achieving Clinical Value
Infoway Focus
• Increased clinical value and not administrative use (e.g. billing)
• Increased clinical value is validated to ensure it is occurring
Infoway Clinical Value Criteria Level 1
• Enter encounter notes
• Enter problem lists, allergies, immunizations and vitals
• Enter new prescriptions/renewals into EMR, which can be printed
• Generate automated alerts and reminders from within EMR
• Receive laboratory results into the EMR
Infoway Clinical Value Criteria Level 2
• Clinician does e-prescribing and receives a complete medication
history and automated medication alerts into the EMR
28
Telehealth
$110 M investment
29
Telehealth Device Deployment
• The deployment of telehealth devices varies across Canada
Deployment
Remote
Monitoring
Teletriage
Teletriage
11 of 13 jurisdictions are enabled with 24/7 telephone triage services.
Service
Video-Conferencing
All Canadian jurisdictions offer established video-conferencing services
to facilitate patient care between providers.
Remote Monitoring
Currently, 8 of 13 Canadian jurisdictions offer localized and emerging
remote patient monitoring services with New Brunswick the only
jurisdiction to offer a province-wide remote patient monitoring service
for patients.
Data Rich Image
Transfer
While teleradiology services are available in all jurisdictions, only 1 is
equipped with widespread telepathology and another 5 are emerging
Teletriage and video-conferencing technologies are mature, while remote
30
monitoring and pathology data rich image devices are emerging in their deployment
Ontario Telemedicine Network
Profile
• One of the largest telemedicine networks
in the world using live, two-way
videoconferencing systems and related
diagnostic equipment.
• Rapidly moving into remote monitoring
and telepathology
• Over 3,000 health care professionals
delivering care
• Services provided via 925 sites across the
province
• In 2009, over 90,000 patient visits in
Ontario were conducted using
telemedicine
• Significant integration with First Nations
communities
31
Telehealth Deployment in Aboriginal Communities
• Through a mix of federal,
jurisdiction and Infoway
support, the majority of
Canada’s first nation
communities are telehealthenabled.
• The focus is aboriginal
communities with health
centres
• Infoway will meet its target of
215 communities by
December 31, 2010 and
exceed that target into 2011.
Independent federal &
jurisdiction investment
32
Consumer Health Solutions
$45 M investment
33
Consumer Health
Patient Portal Functionality
• Find health information A-Z
• Find provider, facility and service information
• Communicate with healthcare providers
• View health record
• Manage medication refills
• View wait times
• Book appointments with family physicians
• View who has looked at your health record
Patient Portal Integration
• Physician offices
• Community pharmacies
• Hospitals
• Private sector offerings
34
Public Health Surveillance
$150 M investment
35
Public Health Surveillance - Panorama
• Panorama solution has been
built which is fully interoperable
with the EHR infostructure
• Functionality
−
−
−
−
−
−
Vaccine
Immunization
Investigations
Outbreak
Alerting
Reporting
• Implementation phase
−
−
−
−
−
−
−
Quebec
British Columbia
Ontario
Nova Scotia
Newfoundland-Labrador
Saskatchewan
Manitoba
36
Public Education Campaign
While the campaign aims to inform the opinions
of all Canadians, the focus will be on those who
are most likely to see the benefits of EHR
systems:
Patients living with chronic conditions –
long-term, frequent users of the system
Family Caregivers – women aged 40+ with
children and are responsible for the health of
their family
Seniors – men or women aged 55+ who are
facing health care challenges; frequent users of
the system and who are interested in health
policies
37
Campaign components
The campaign will use TV, print, online and news media outreach,
as well as an informational microsite, to inform Canadians about
the benefits of EHR systems
TV
Print
Knowingisbetter.ca
Online Banners
Knowing is Better than Not Knowing
38
Some Final Thoughts – on Building Bridges
• Building Bridges … to think through healthcare and information technology
as a country and not just as 14 individual healthcare systems
• Building Bridges … to reach a common understanding of what information
needs to be exchanged across care settings (the continuum of care) so we
can achieve improved clinical value
• Building Bridges … to those clinician communities who have been relatively
slow to adopt technology
• Building Bridges … to elected
officials across Canada to obtain
their continual commitment and
support for a 10-15 year journey
• Building Bridges … to the public to
ensure so they understand what we
are doing and the benefits that
they will receive
39
Thank you