1. Contributing to health care quality, accessibility and productivity
eHealth:
Contributing to health care quality, accessibility and productivity
Sarah Muttitt , Vice-President, Innovation and Adoption, Canada Health Infoway October

2. Each year, almost all of these records are hand-written
100 million physician exam records
400 million prescriptions
500 million lab and radiology tests
The paper jungle
In spite of spectacular advances in medicine, the foundation of health care delivery in Canada is still paper-based: 2

3. Wrong decisions being made
Current challenges
TREATMENT AND RECOVERY
DIAGNOSIS
PREVENTION
Poor compliance with prevention guidelines
Huge opportunity for errors, poor customer service, and repeat diagnostic tests
Wrong decisions being made
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
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

4. The need for health information management
Providers, managers, patients, public are demanding more
IT has potential to enable solutions to address pressures
Consumerism is growing
Population is aging
Pressures on resources are greater
Care settings are shifting

5. Where are we today? Country Physicians who use EMRs Netherlands 98%
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 %
Canada %
The Conference Board’s study looked at Canada’s performance against countries in the Organization for Economic Co-operation and Development: Japan, Italy, France, Spain, Korea, Switzerland, Sweden, Finland, Austria, Norway, the United States and the United Kingdom

6. Annual IT spending Percentage 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.
Annual IT spending Percentage of total budgets/revenues
5.4
4.7
4.5
4.0
3.4
2.9
1.5 – 2.0
Education
US HC providers
UK health care
Calgary Regional Health Authority
Professional services
US banking/ financial services
HC IT spend Canadian jurisdictions

7. Canada Health Infoway Mission: Goal: 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.
Infoway’s mandate, as endorsed by our funders, members and jurisdictional partners is to increase the use of electronic health records for the purposes of improving the provision of health care.

8. 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.

9. Access to detailed data
Results and images
Patient information
Medical alerts
Medication history
Interactions
Problem list
Immunization

10. EHR: Overall benefits and value
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 – $12 billion
Benefits: $ 6 billion – $7 billion in savings annually

11. 53 projects 233 projects March 2004 = $123 million
Phase 2 Projects
Phase 0/1 Projects
System in place
June 2007 = $1.203 billion
233 projects 11

12. 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.
NET BENEFITS
System quality
Functionality
Performance
Security
Quality
Patient safety
Use
Appropriateness/
Use Behavior/
effectiveness
Pattern
Health outcomes
Self Reported Use
Intention to Use
Information
quality
Content
Availability
Access
Ability of patients/providers
to access services
User
Satisfaction
Competency
User Satisfaction
Ease of Use
Patient and caregiver
participation
Service
quality
Responsiveness
Productivity
Efficiency
Care coordination
Net cost

13. An expanding EHR circle?
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 13

14. Ancillary Data & Services Registries Data & Services
The EHR Blueprint
JURISDICTIONAL INFOSTRUCTURE
POINT OF SERVICE
Terminology Repository
Ancillary Data & Services
Registries Data & Services
EHR Data & Services
Immunization Management
PHS Reporting
Shared Health Record
Drug Information
Diagnostic Imaging
Laboratory
Hospital, LTC, CCC, EPR
Physician Office EMR
EHR Viewer
Physician/ Provider
Business Rules
EHR Index
Message Structures
Normalization Rules
Security Mgmt Data
Privacy Data
Configuration
Lab System (LIS)
Lab Clinician
Radiology Center PACS/RIS
Radiologist
Pharmacy System
Pharmacist
Public Health Services
Public Health Provider
Longitudinal Record Services
HIAL
Communication Bus
Common Services
Client Registry
Provider Registry
Location Registry 14
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
Data Warehouse
Data Warehouse
Health Information
Health Information
The clinical information systems identified in the EHR Blueprint are the Infoway-mandated priorities and, at least in the short term, will be the primary drivers that will determine what data is available for non-clinical use
In general, this data will not be sufficient to meet the vast and diverse requirements of researchers, health system managers and others
There will continue to be a need for ancillary data sources – this will require strategies to access or interface with those sources as well as to standardize data from those sources
It is important to reduce parallel data collection where possible, so it is important to take the steps to better understand the data requirements related to secondary use now versus later in order to plan effectively and optimize the contribution the EHR can make

15. Thank you 15