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Drivers of Healthcare Renewal in Canada
Health information technology is currently one of the most dynamic sectors in Canada and in many other countries. It is widely acknowledged that healthcare providers need to access a patient's key health information during a consultation. Now, steps are being taken to make this vision a reality. Similar information systems have been available in the banking and insurance industries for years. Therefore, accessible health records are viewed by the majority of Canadians as a natural next step for health information technology.
Paper-based health records make it difficult for clinicians to retrieve or share patient information, thereby posing potential risks related to patient safety. Numerous recent studies have revealed the limits of the current paper-based system, as well as the potential significant benefits that information technology solutions can contribute to the improvement of healthcare quality and patient safety.
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A few examples demonstrating the inefficiencies of current paper-based record systems: |
| For every 1000 hospital admissions |  | 75 will suffer an adverse event |
| For every 1000 patients with an ambulatory encounter | | 20 will suffer a serious adverse drug event |
| For every 1000 patients discharged from hospital | | 90 will suffer a serious adverse drug event |
| For every 1000 laboratory tests performed | | up to 150 will be unnecessary |
| For every 1000 emergency visits | | 320 patients had an information gap, resulting in increased stays |
| In a study of 168 traditional medical records | | 81% lacked information for patient care decisions |
Furthermore, issues such as the dramatic rising cost of healthcare, new public health threats, increased wait times and an aging population have motivated Canada's government leaders to make significant investments in improving the healthcare system.
Federal, provincial and territorial governments are motivated to improve our health system
Governments are concerned with healthcare because protecting their citizens – including their health – is a core responsibility. Since healthcare in Canada falls under provincial and territorial jurisdiction, joint motivation and political will is needed to create the foundations of common electronic health records across Canada.
Canada Health Infoway was founded in 2001 as a strategic response by federal, provincial and territorial governments to coordinate and accelerate health information technology initiatives across Canada.
Canada Health Infoway's mission is 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.
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Build on existing initiatives and pursue collaborative relationships in pursuit of our mission.
To meet its mandate, Infoway has received $1.2 billion in capital from the Government of Canada. The funding will be used to collaborate and co-invest with jurisdictions in a cost- and time-effective manner.
Infoway's goal is to fully implement an interoperable electronic health record solution across 50 per cent of Canada's population by December 31, 2009.
The Interoperable Electronic Health Record Program
Infoway is currently investing in nine targeted program areas, one of them being the Interoperable Electronic Health Record (iEHR) Program.
The goal of this program is to implement solutions that will allow authorized healthcare providers to view key integrated patient-centric health data anywhere, anytime in support of high quality care. Patient information will be shared among health providers via the electronic healthcare record. This secure and lifetime record is designed to facilitate the sharing of data – across the continuum of care, across healthcare delivery organizations, and across geographical areas.
By implementing iEHR Solutions across Canada, Infoway intends to:
- improve the quality, safety, accessibility, and timeliness of care;
- support more informed healthcare decision-making;
- to improve the efficiency of the healthcare system; and,
- to reduce costly duplication of testing and imaging.
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The New World
Patient- & family-focused
Wellness
Continuum of care
Disease management
Demand management
Collaborative, evidence-based decisions
Effectiveness
Centralized, specialized care
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The New World
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Patient- & family-focused
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Wellness
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Continuum of care
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Disease management
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Demand management
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Collaborative, evidence-based decisions
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Effectiveness
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Centralized, specialized care
The majority of Canadian provinces and territories are currently conducting detailed planning or deployment of their iEHR solutions. To date, Infoway has invested $25 million in these iEHR projects. We anticipate that most of the jurisdictions will be in an implementation mode within the upcoming fiscal year, and that most of the $175 million iEHR funds should be committed by then.
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To share key patient health data between providers across Canada, all solutions must be founded on interoperability. To achieve such compatibility, it is fundamental that all parties develop their solutions using the same basic rules. Architecture and standards are two of the key elements on which to build common rules. Infoway has developed a blueprint that meets this goal and also allows the jurisdictions to address their own priorities. It has also set up a Standards Collaboration Process to guide and govern the establishment of pan-Canadian EHR standards.
Figure 1 (below) shows the high-level architecture of the overall Infoway iEHR solution. This diagram can be divided into three main sections. The upper portion contains the data repositories holding the patient information by category, such as identification (client, provider, and location registries), patient-specific information (drugs, allergies, referral summaries, hospital discharge summaries, lab and diagnostic imaging results, etc.), and public health surveillance information.
The middle level of the diagram includes the Longitudinal Record Services (LRS)and the Health Information Access Layer (HIAL). These components can be viewed as the brain that makes the whole solution work. The main role of the LRS and HIAL is to track and organize relevant historical health information on any given patient.
Finally, the bottom section of the diagram corresponds to the point of service where this information can be viewed. Within the context of Infoway investments, the iEHR viewer is the main element of interest. This viewer allows authorized health professionals to view the information contained in the data repositories described above. The iEHR viewer is meant to present healthcare providers with key shared patient-centric information – it is not meant to replace the provider's clinical information system or medical record – but serves as a complementary tool with supplementary information. The foremost value of the iEHR viewer is that it allows healthcare providers to view a patient's historical health information simply by using one application. The information obtained, however, comes from different healthcare locations or resources and can include results (such as diagnostic images or lab tests) requested by different providers, as well as details of distinct healthcare encounters.
figure 1
click image for a closer look (opens in new browser window)
The interoperability requirement, which is the heart of this global system, has led Infoway architects, jurisdictions, and vendors to surpass existing boundaries. Efforts were coordinated to develop a health information model that accommodates pan-Canadian needs, is adaptable for use by both very small and large jurisdictions, and is reasonably affordable. The creation of this Canadian health information model resulted in further innovations attained through development of solutions based on these established norms.
A strong national consensus that an electronic health record would improve healthcare in Canada has set us on the information highway toward achieving this goal. By harnessing innovations in health information technology, we will be able to build the required infostructure to support the national EHR. Along the way, we are also fostering the development of interoperable technologies and systems that will provide benefits for the years to come. We've taken the first steps and there's still much to accomplish, but we are well on our way. The goal is in sight and, by working together, Canadians are already beginning to experience the benefits of the electronic health record.
Luc Bouchard, iEHR Group Director, Canada Health Infoway
Mélodie Faucher, Program Business Analyst, iEHR Program
www.infoway-inforoute.ca
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