1Diagnostic Accreditation Program Conference | Presentation by Jim Mickelson, Executive Director – Western

Canada| Canada Health Infoway | May 12, 2008

Investing in BC Investing in BC eHealtheHealth

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Visibility

TechnologyTrigger

Peak of InflatedExpectation

Trough ofDisillusionment

Slope ofEnlightenment

Plateau ofProductivity

Maturity

Gartner “Hype” CycleGartner “Hype” Cycle

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Computers make it easier to do a lot of things, but most of the things they make it easier to do don't need to be done.- Andy Rooney

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Visibility

TechnologyTrigger

Peak of InflatedExpectation

Trough ofDisillusionment

Slope ofEnlightenment

Plateau ofProductivity

Maturity

Gartner “Hype” CycleGartner “Hype” Cycle

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I have not failed. I've just found 10,000 ways that won't work.- Thomas Edison

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<<Province X>> to develop information network

---------------------------------------------------------------------------

The <<Province X>> government has signed a 5-year contract with

<<Company y>>. for the development of a health-information network

that will link authorized professionals across the province and provide

fast access to patient information such as prescriptions, treatment and

immunization history, and laboratory and x-ray results. The government

believes the $100-million cost of the computer system will be recovered

quickly through increased efficiency, reduced health care fraud and the

creation of new preventive-care programs.

-CMAJ – June 1, 1996

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Infoway releases technology blueprint that will

guide and accelerate the development of

interoperable electronic health records in Canada

Montreal, July 29, 2003 - Canada Health Infoway today released its electronic

health record solution blueprint (EHRS Blueprint). The Blueprint is a fully validated,

scalable business and technical architecture that will guide the development of

EHR solutions in Canada. It represents a major milestone toward achieving

Infoway's mission of accelerating the implementation of these systems in support

of improved quality of care and patient safety.

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The need for EHR The need for EHR

in Canadain Canada

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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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• Accurate information that moves with them

• Communication between their various health care providers

• Protection of their privacy

• Input into decisions

• Elimination of undue risk

• Timely access/results

EKOS survey of 2,000 Canadians, 2003

EKOS survey of 2,500 Canadians, 2004

Great expectationsGreat expectationsWhat Canadians expect from their health care system:

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Interoperability challengesInteroperability challenges

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700 hospitals 40,000 general practitioners

315,000 nurses 29,000 specialists 26,000 pharmacists 1,600 long-term care facilities

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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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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 healthcare 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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Improving the productivity of healthcare saves costs and makes optimal

use of available human and otherresources.

Reduced wait times

EHR: Overall benefits and value

Improving quality improves health, reduces the burden on the system,

and ensures optimaluse of capacity.

Productivity• Provides time savings• Avoids unnecessary diagnostics, procedures and visits• Optimizes coordination of human resources

Productivity• Provides time savings• Avoids unnecessary diagnostics, procedures and visits• Optimizes coordination of human resources

Access• Timely delivery of care• Increased interpretations by remote specialists• Improved 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• Increased patient access and use of their health record

Quality• Better continuity of care improves disease and

case management • Appropriate care adheres to standards• Prevention of adverse events and public health threats

Quality• Better continuity of care improves disease and

case management • Appropriate care adheres to standards• Prevention of adverse events and public health threats

Capital cost: $10 billion to $12 billion

Benefits: $6 billion to $7 billion in savings annually

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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 healthcare

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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InfowayInfoway programs programs

Innovation and Adoption - $60 million*

Public Health

Surveillance

$135 million

Telehealth

$100 million

Innovation and Adoption – $60 million

Chronic Diseases

Cancer

Primary Care

Mental Health

Laboratory Systems

$170 million

Diagnostic Imaging

$340 million

Interoperable EHR – $365 million

Infostructure – $32 million

Registries

$134 million

Drug Systems

$250 million

Patient Access to

Quality Care

$50 million

End-user Adoption and Setting the Future Direction

Healthcare Applications and Innovation Projects

The Electronic Health Record

Registries and Domain Repositories

Architecture and Standards

Ten investment programs totalling $1.636 billion

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December 2007 = $1.332 billionDecember 2007 = $1.332 billion

Phase 2 Projects

Phase 0/1 Projects

System in place

245 projects **

** Includes 93 pan-Canadian projects not shown

•Approximately $150 million invested in BC

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Progress to dateProgress to dateJurisdictional Progress to March 31, 2008

Note:1. “Percent Deployed” is the percent of the Canadian population covered by the solution2. To depict both full and partial progress “Percent Deployed” is calculated as 100% of the jurisdiction population if the project is complete

and 50% of the jurisdiction population if the project is in the adoption phase

AB

Implementation

Domain

Complete

Status:

Planning

Adoption

Forecast

Clientregistry

Jurisdiction

NU

SK

Providerregistry

YT

BC

Lab PHSiEHR

NL

PE

DrugDI

NB

NT

NS

QC

MB

71 7302429 064Percent Deployed at Mar.31, 2008

ON

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British Columbia British Columbia

Investment SummaryInvestment Summary

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Deciding on the RightDeciding on the Right InvestmentsInvestments

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EHR ArchitectureEHR Architecture

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Infoway DI Investments in BCInfoway DI Investments in BCFraser Health

»One of Infoway’s first investments

»Supported regional PACS implementation and a single repository

Interior Health

»Supported the completion of the regional PACS implementation and a single repository

Provincial

»Plan being revised to align with provincial ehealth priorities

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Key Findings: PACS EvaluationsKey Findings: PACS EvaluationsImprovement in productivity

After one year of implementation, BC’s Fraser Health Authority had a 17% reduction in operating cost per exam in a PACS environment in comparison to a pure film environment, ($37/exam vs $44/exam)

87% of Radiologists and 73% of Referring Physicians indicated that PACS has increased their reporting and consultation efficiency

Across BC’s Interior Health Authority project sites (n=22), average Report Turn Around Time decreased by 41%

Decrease in Report Turn Around Time following PACS Implementation

41%51% 53%

0%

20%

40%

60%

All sites Rural sites Sites without on-siteRadiologist

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Infoway Drug Investment in BCInfoway Drug Investment in BC

eDrug

»Builds on “All Drugs All People” repository of Pharmanet

»Adds additional content (e.g. in-hospital medications)

»Adds eprescribing

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Infoway Lab Investment in BCInfoway Lab Investment in BC

Provincial Lab Information System (PLIS)

»Managed in conjunction with the BC iEHR project»Planned to be the first ehealth “clinical domain” deployed through the ehealth infostructure»Provides for a provincial lab repository

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EHR ArchitectureEHR Architecture

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Infoway Registries Investment in BCInfoway Registries Investment in BC

Provincial Client and Provider Registries»Provincial Client Registry to enable accurate identification of patients connected with their EHR data»Provincial Provider Registry enables accurate identification of providers and for them to be appropriately connected with EHR data

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EHR ArchitectureEHR Architecture

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Infoway iEHR Investment in BCInfoway iEHR Investment in BC

Provincial EHR Infostructure»Enables sharing of EHR data from multiple domains»Enables appropriate privacy and security»Includes “Secure Health Record” – clinically relevant data not available in the drug, DI, and Lab repositories

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Other Infoway Investment in BCOther Infoway Investment in BCPublic Health Surveillance

»Panorama application implementationTelehealth

»Clinical expansion and First Nations telehealth expansionInnovation and Adoption

»Patient Safety and Learning System»Mental Health and Addictions Patient Flow

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Forecasted Progress to March 31, 2009

2008–09 action plans2008–09 action plans

Note:1. “Percent Deployed” is the percent of the Canadian population covered by the solution2. To depict both full and partial progress “Percent Deployed” is calculated as 100% of the jurisdiction population if the

project is complete and 50% of the jurisdiction population if the project is in the adoption phase

AB

Domain

Clientregistry

Jurisdiction

NU

SK

Providerregistry

YT

BC

Lab PHSiEHR

NL

PE

DrugDI

NB

NT

NS

QC

MB

ON

76 28515963 3379Percent Deployed at Mar.31, 2009

Implementation

Complete

Status:

Planning

Adoption

Forecast

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The promiseThe promise• Increased patient

participation in care

• Well-managed chronic illness

• Improved access to care in remote and rural

communities

• Fewer adverse drug events

• Better prescribing practices

• Reduction in duplicate or unnecessary tests

• Reduced wait times

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Thank you!Thank you!

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