Insights into the Canadian eHealth Landscape

April 10, 2013

MaRS Future of Medicine Series Shelagh Maloney Canada Health Infoway

#FOMmarsdd.com/fom

April 10, 2013

Insights into the Canadian eHealth LandscapeShelagh Maloney

Agenda

About Canada Health Infoway Progress in Canada Looking forward Opportunities Challenges/Enablers

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Canada Health Infoway •  Independent, not-for-profit corporation •  Equally accountable to 14 F/P/T governments; the Members •  Independent Board of Directors appointed by the Members

•  mix of public and private sector representatives •  public sector representatives are regionally focused

Vision •  Healthier Canadians through innovative e-health solutions

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Canada Health Infoway

•  Since 2001 the Federal Government has provided $2.1 B in capitalization

–  $500M: Electronic Health Records (2001) –  $600M: Electronic Health Records and Telehealth (2003) –  $100M: Health Surveillance Systems (2004) –  $400M: Electronic Health Records and Wait Time Systems (2007) –  $500M: EHR, EMR, Consumer Health (2010)

•  This has been matched by the provinces and territories so that the spend today is over $3B

•  Infoway’s role is one of strategic investor •  Lead, invest, advise and monitor

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Engagement Approach Partnership built on Collaboration

•  Shared governance – represented by the federal, provincial and territorial governments

•  Pan-Canadian approach – a common national direction, leveraging investments and replicating solutions but with local flexibility

•  Collaboration – working together with jurisdictions to plan and implement a pan-Canadian health infostructure

•  Sharing of cost and risk – co-investing with jurisdictions in the successful modernization of health information technology across Canada

•  Benefits driven – clearly demonstrating what was achieved for the investment

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•  Infoway targets investment to one of 12 investment programs •  Programs are at different stages of maturity

Infoway Investments

Note: There is also significant additional local ehealth expenditures happening (e.g. new or upgraded hospital systems) that are not accounted for here but do contribute to the implementation of this agenda

Telehealth $110m

Diagnostic Imaging $365m

Registries $134m

Infostructure - $52m

Drug Systems $250m

Laboratory Systems $170m

Interoperable Electronic Health Record $365m

Public Health Surveillance

$150m

Patient Access to Quality Care $50m

Innovation and Adoption $105m

EMR and Integration

$340m

Consumer Health Solutions

$45m

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Architecture

EHRS

EHRS EHRS

EHRS EHRS EHRS

EHRS EHRS

EHRS

EHRS

.…. Linked jurisdiction networks – a distributed, message-based, peer-to-peer network of ehealth systems across Canada

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•  Infoway Standards Collaborative; a single national group for standards development, support and maintenance

•  Standards necessary to allow data and document sharing – for example, HL7 CCOW, HL7 v2.4, HL7 v3, HL7 CDA

•  International propagation of the standards developed in Canada •  Infoway investments require standards compliance

Messaging

HL7 and DICOM are the primary

standards for the electronic exchange of clinical and

administrative data

Terminologies

LOINC and SNOMED CT are the primary terminologies

for coding of clinical information

Interoperability Profiles

Define functional behaviours of components of the EHR

system

Standards Ensuring Interoperability and Privacy

Progress in Canada

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Availability Use

Benefits

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Availability of information for authorized users

Client Demographics 99.9%

Provider Demographics 99.9%

Diagnostic Images 99.9%

Dispensed Drugs 56%

Lab Test Results 77%

Clinical Reports or Immunizations 93%

*Availability does not measure the extent of use by providers, but rather the information and systems that are in place.

2013

Telehealth Videoconferencing in 97% of Hospitals

ClinicalTelehealth

Consultations

ElectronicMedical  Recordusers  (primary

care)

DiagnosticImaging

Systems  users

DrugInformationSystems  users

LaboratoryInformationSystems  users

195% 143% 161% Es#mated  increase  in  users  and  consulta#ons  over  a  seven-­‐year  period  to  2012-­‐2013  

Sources: 2013 Canadian Telehealth Report, CTF/COACH, National Physician Survey, 2000, 2006, 2009, 2011 & Commonwealth Fund 2012, Infoway Diagnostic Imaging, Drug Information Systems, and Lab Information Systems Program Data, 2005-2012

254%

…and will grow as the larger jurisdictions add new clinical users

524%

Use of the information has increased significantly…

Benefits evaluation approach •  Inform future investment •  Encourage end user adoption •  Highlight necessary adjustments

or best practice

•  Invest in evaluation with a sample of projects

•  Framework supported with indicators and standard survey

•  Produce benefits reports

Why

How

Use •  Use Behavior/Pattern •  Self Reported Use •  Intention to Use

User Satisfaction •  Competency •  User Satisfaction •  Ease of Use

Service quality •  Responsiveness

Productivity •  Efficiency •  Care coordination •  Net cost

Quality •  Patient safety •  Appropriateness/effectiveness •  Health outcomes

Access •  Ability of patients/providers to access services •  Patient and caregiver participation

NET BENEFITS

Information quality •  Content •  Availability

System quality •  Functionality •  Performance •  Security

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Improving access to care and boosting productivity with digital diagnostic imaging

• 99% of x-ray, CT, MRI, etc in public hospitals now digital

• Reduces lag time for diagnosis, need for travel, health care costs

• Benefits currently valued at > $600 million/year

• 25-30% increase in radiologists’ productivity, equivalent of up to 500 additional specialists once investments are complete

Source: Diagnostic Imaging Benefits Evaluation Final Report, True North Consulting, 2008

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Improving medication management & safety with drug information systems • Enables complete medication profile, based on all dispensed prescriptions ~ available for 54% of population as of March 2012

• Benefits currently valued at > $400 million/year in 2010

• Pharmacists report decrease in potential drug-related problems, e.g. drug interactions

• Other benefits include reduced prescription abuse and improved patient compliance

Source: National Impacts of Generation 2 Drug Information Systems, Deloitte, 2010

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Connecting patients to care with telehealth

• Telehealth videoconferencing in 90% of hospitals

• Enables patients to remain in their communities for some or all of their specialized care

• > 500% growth in use in recent years

• 47 million fewer km of travel for care in 2010

• $55 million in benefits for the health system

Source: Telehealth Benefits and Adoption: Connecting People and Providers Across Canada, Praxia & Gartner, 2011

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Looking Ahead

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• Consult extensively

• Define success ~ value ~ consumers, clinicians, governors •  Identify opportunities for action

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Stakeholders representing consumers (37%), clinicians (25%), government & administrators (30%), vendors (3%) and others (5%) from across Canada were consulted between October 2011 and February 2012

More than 500 stakeholders were consulted

Interviews  

14  one-­‐on-­‐one/small  group  mee#ngs  with  jurisdic#on  Deputy  Ministers  of  Health  and  key  representa#ves  

Stakeholder  Forums  

10  regional  stakeholder  forums  were  held  in  Vancouver,  Edmonton,  Winnipeg,  Toronto,  OIawa,  Montreal  and  Halifax,  including  sessions  with  the  federal  government,  na#onal  associa#ons,  the  Privacy  Forum  and  Government/RHA  CIOs  

Focus  Groups  

39  stakeholder  focus  groups  with  individual  Canadians  and  clinician  groups    

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Improve the patient experience

Bring Care Closer to Home

Provide Easier Access

Improve Patient Safety Enable a High-Performing

Health System Support New Models of Care

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Bring care closer to home

Opportunities Using mobile patient monitoring solutions, coupled with other consumer health solutions, chronic disease and other patients will be able to monitor their own health conditions from home.

—  Aggregate and analyze patient monitoring data and alert clinicians so that appropriate and timely interventions occur

—  Clinical consults and social visits with video link (e.g. wound care)

—  Send patients automated alerts & reminders —  Health management, wellness and educational tools

Provide easier access Opportunities More convenient health care experience through the use of e-health solutions to better interact with health care team and navigate the health care system.

—  Communications: another channel for patient-provider —  e-scheduling —  e-prescription renewal —  Finding (in context to geo-location) —  Journaling: share self-reported

health information with clinician —  Alerts

Support new models of care Opportunities Enable person-centred care and continuity of care, including chronic disease management.

Clinicians

—  Tool for communication and collaboration among clinicians

—  Monitor from a distance

Patients —  Behavioral modification, compliance

(e.g. gaming) —  Promote and enable patient

self-management

Improve patient safety Opportunities Reduce preventable medical errors and adverse outcomes.

—  Medication reconciliation “at the bedside” • Ordering • Drug utilization review • Administration

—  Real-time, content-rich communications among clinicians

—  Remote tracking or real-time feeds (e.g. fetal or cardiac monitors)

Enable a high-performing health system

Opportunities Analytics solutions to support the creation of information and evidence for clinical and administrative decision making on mobile devices.

—  Access to guidelines —  Access to KPIs for clinical and administrative insights

It’s not just about the IT…

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Opportunities for action and key enablers

Policy  &    Legisla=on  

Resource  Capacity,  Capability  &  Culture  

Prac=ce  &  Process  Change  

Privacy  &    Security   Interoperable    

e-­‐Health  Solu=ons  

Business  Case  &  Benefits  Realiza=on  

Governance  &  Leadership  

Support New Models of Care

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Last Thoughts

“The digital world – the Internet and the cloud and supercomputing and social networking – is breaking medicine out of its cocoon. It’s a super convergence we’ve seen in other walks of life but not in the health and medical sphere.”

Source: Eric Topol, MD, Wired Magazine, February 2012 The Blockbuster Drug of the Century: An Engaged Patient “Healthcare must be built on a foundation of Health IT-supported care coordination and patient engagement, there is no other way to consistently and quickly scale improvements and care, and to accelerate the overall learning of the health care system.”

Source: Blog Post by Leonard Kish on August 28, 2012 http://www.hl7standards.com/blog/2012/08/28/drug-of-the-century/

THANK YOU

Website: www.infoway-inforoute.ca email: smaloney@infoway-inforoute.ca

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