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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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