ehealth in Canada Transforming and modernizing care

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e-health in CanadaTransforming and modernizing
care
Presentation by John Burns, Senior VP,
Investment Programs Managementto the Danish
DelegationApril 2, 2009
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The Canadian context
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Canada large country, small population

• Second largest country in the world
• Population density among the lowest in the world
  32.5 million people/3.5/km2
• Canadian population concentrated to Canada/United
  States border
• Vast regions of Canada sparsely populated

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Governance of health care a shared
accountability

• Federal government sets and administers national
  principles
• 13 provincial/territorial governments plan,
  finance, manage, evaluate health services
• 100 health regions coordinate care delivery over
  a set geographical area
• 700 hospitals and 1,600 long-term care
  facilities manage care
• Approximately 400,000 general practitioners
  deliver care along with specialists, nurses,
  pharmacists, and health care professionals

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Health care in Canada

• 170 billion-plus business
• 60 of cost for hospitals, drugs and physicians
• 7030 public vs. private funding

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Health care pressures

• Aging population
• Rising incidence of chronic disease
• Wait times
• Health care spending
• Political debates over private role in health
  care delivery
• Sustainability
• Meeting expectations

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Great expectations

• What Canadians expect from their health care
  system

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The need for electronic health records

• For every 1,000

• in Canada

• 75 people will suffer an adverse drug event

• hospital admissions

• patients with an ambulatory encounter

• 20 people will suffer a serious drug event

• patients discharged from hospital

• 90 people will suffer a serious adverse drug event

• laboratory tests performed

• up to 150 will be unnecessary (range 50-150)

• emergency department visits

• 320 patients have an information gap identified,
  resulting in an average increased stay of 1.2
  hours

• Canadians recommended for influenza protection

• 370-430 are not vaccinated

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Canadas most information-intensive industry is
last frontier in information technology

• In spite of spectacular advances in medicine, the
  foundation of health care in Canada is still
  paper-based.
• Each year, almost all of these records are
  hand-written
• 100 million physician exam records
• 500 million lab and radiology tests
• 400 million prescriptions

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Canada invests less in health IT than other
information-intensive businesses

• Canadas health care system would rank No. 10 in
  the Fortune 500 and is three times the size of
  Royal Bank, but has limited ability to manage its
  information.

Annual IT spend Percentage of total
budgets/revenues
Range of health care IT spend of Canadian
jurisdictions
2.0
1.5
Calgary Regional Health Authority
US banking/financial services
HS HC providers
UK health care
Professional services
Education
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The need for health information management

• Consumerism is growing

• Population is aging

Providers, managers, patients, public are
demanding more IT has potential to enable
solutions to address pressures

• Pressures on resources are greater

• Care settings are shifting

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The benefits and value of electronic health
information technologies

• 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

ACCESS

• Improved interpretation of diagnostic and
  laboratory results
• Decreased adverse drug events
• Decreased prescription errors
• Increased speed and accuracy in detecting
  infectious disease outbreaks

QUALITY

• Increased access to integrated patient
  information
• Reduced duplicate tests and prescriptions
• Reduced physician prescription call-backs
• Reduced patient and provider travel costs

PRODUCTIVITY
Capital cost 10 billion to 12 billion
Benefits 6 billion to 7 billion annually
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About Infoway
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Canada Health Infoway

• Created in 2001
• 2.1 billion in federal funding
• Independent, not-for-profit corporation
• Accountable to 14 federal/provincial/territorial
  governments

Mission Fostering and accelerating 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.
Infoway will build on existing initiatives and
pursue collaborative relationships in pursuit of
its mission.
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The vision for health care

• 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.

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Smart moves
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Infoway business strategies

• Targeted programs
• Collaborate with health ministries and other
  partners
• Co-invest with public sector partners (7525
  formula)
• Leveraged investment
• Form strategic alliances with the private sector
• Manage risk and ensure quality solutions
• Measure benefits and adjust
• Strategic investor
• Economic development
• Certification

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Points of care
Homecare
Emergency Services
Clinic
Community Care Centre
Pharmacy
Specialist Clinic
Laboratory
Diagnostic
Hospital Emergency
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One patient, one record
Results and images
Patient information
Medical alerts
Medication history
Interactions
Immunization
Problem list
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EHR architecture
Longitudinal Record Services
Common Services
Communication Bus
JURISDICTIONAL INFOSTRUCTURE
Ancillary Data Services
EHR Data Services
DataWarehouse
Registries Data Services
ImmunizationManagement
PHSReporting
SharedHealth Record
DrugInformation
DiagnosticImaging
Laboratory
HealthInformation
ClientRegistry
ProviderRegistry
TerminologyRepository
BusinessRules
EHRIndex
MessageStructures
NormalizationRules
LocationRegistry
Security MgmtData
Privacy Data
Configuration
HIAL
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Economic impact

• For every dollar that Infoway and its
  jurisdictional partners invest in the electronic
  health records programs, an additional 1.34 is
  added to overall GDP.
• For every 100 million invested in e-health,
  1,525 jobs will be created, of which about 50
  are information technology (knowledge worker)
  positions.
• For every 100 million invested in e-health an
  estimated 42 million in corporate pre-tax
  profits will be generated.
• Overall, each 1 dollar invested by Infoway
  results in an estimated 25 cent improvement in
  the federal fiscal position and an 11 cent
  improvement in the aggregate jurisdictional
  fiscal position.

Based on 2007 report by the Conference Board of
Canada
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EHR vs. EMR
Health Information Access Layer (HIAL)
Longitudinal Record Services
Diagnostic Imaging
Lab
Registries
Hospital Other
Drug
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Progress across Canada
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Progress across Canada
276 active and completed projects with an
estimated value of 1.527 billion as at Dec. 31,
2008
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Signposts of success
Access
Productivity
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Infoway benefit evaluation framework

• The framework articulates the link between the
  systems in which Infoway invests and the
  resulting benefits, providing a basis for
  measurement.

• System quality
• Functionality
• Performance
• Security

• NET BENEFITS
• Quality
• Patient safety
• Appropriateness/effectiveness
• Health outcomesAccess
• Ability of patients/providers to access
  services
• Patient and caregiver
• ParticipationProductivity
• Efficiency
• Care coordination
• Net cost

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

• Information quality
• Content
• Availability

• User Satisfaction
• Competency
• User Satisfaction
• Ease of Use

• Service quality
• Responsiveness

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Preventing adverse drug eventsPharmaNet

• Drug information system captures every
  prescription dispensed in BC pharmacies
• More than 47 million prescriptions processed in
  2007 with PharmaNet
• 24 million potential drug interactions flagged
• 2.5 million significant drug interactions
  identified
• 29,000 changes were made after consultation with
  prescribing physician
• Comprehensive drug information systems being
  implemented across the country

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Expanding the circle of careEMRxtra

• Pharmacists in Sault Ste. Marie have access to
  consenting patients EMR data to flag potential
  adverse events
• Improved clinical interactions between clinicians
  and with patients
• 97 increase in pharmacist-primary care provider
  activities
• 57 increase in pharmacist-patient activities
• Improved perceived quality of interactions
• Improved ability to manage patients medications
• 94 more drug-related problems identified
• 246 increase in medication management
  recommendations made by pharmacists to PCPs
• Fewer medication list discrepancies identified
• 97 of patients (the majority of whom are
  diabetes and congestive heart failure patients)
  have consented to share information with their
  pharmacist

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Improving access to care and boosting
productivityDI across Canada

• Clinicians in urban centres can review images of
  patients in rural areas instantly, reducing lag
  time for diagnosis, need for travel and lowering
  costs
• On average, DI delivers 25-30 improvement in
  radiologists productivity
• More than half of referring physicians indicate
  DI improved efficiency of clinical
  decision-making by 30 to 90 minutes per week
  capacity increase equivalent of up to 500
  additional specialists across Canada
• 39 of radiologists now reporting for new remote
  sites improved remote reporting enables
  radiologists to support care delivery and improve
  access for remote geographies and populations
• 30-40 improvement in turnaround times (clinical
  decisions and subsequent treatment of patients
  now occurs 10-24 hours sooner)
• Eliminates 10,000-17,000 patient transfers each
  year

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Improving the management of chronic
diseaseAlbertas Capital Health chronic disease
management registry

• EHR-based clinical tool to capture and track key
  patient information
• Provides timely information and helps identify
  patients with diabetes and improves the
  management of the disease
• Generates lists of high-risk patients enabling
  care providers to follow-up proactively
• Registry providing better information on disease
  prevalence administrative system indicated only
  4.4 per cent of the population in the Edmonton
  area has diabetes whereas the CDM registry
  shows the prevalence at more than eight per cent
• The registry contains data on 14,000 diabetic
  patients, 63 of whom are in optimal control
  compared to the national average of 51

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Conventional approach to chronic disease
management
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New approach to chronic disease management
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Challenges to overcome

• Privacy
• Interoperability of vendor systems
• Jurisdictional capacity
• Clinician adoption
• Patient engagement
• Demonstrating benefits
• Continued capitalization

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The 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
• Saving lives

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Thank you

• Thank you