1 Presentation by Richard Alvarez | President and CEO, Canada Health Infoway | February 22, 2008

The Canada Health Infoway PlanThe Canada Health Infoway Plan

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• The Canadian context• The need for EHR in Canada• Infoway’s mission, approach, programs• Progress across Canada • Value to stakeholders• Challenges and opportunities

Overview

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The Canadian context

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Canada is a large Canada is a large countrycountry

Geographic size

Second largest country in the world – 10M km2

6 time zones

7% of world’s renewable fresh water supply

Governance

Federal, 10 provincial and 3 territorial governments

British Parliamentary system

A Commonwealth nation

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Population Size and Location

32.6 million people - 3.3/km2 - among the lowest population densities in world

76% urban; 24% rural

Most live within 400km of the US border

Ethnically Diverse

British Isles: 28%

French: 23%

Other European:15%

Non-European: 6%

Mixed heritage: 25%

Aboriginal: 3%

Canada has a small Canada has a small populationpopulation

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Internet Usage

68% of Canadians use the internet (2005)

• 91% for e-mail• 65% weather, travel• 62% news, sports• 55% banking, pay bills

Broadband Availability

Greatest broadband penetration in G7

76% of households using the internet in Canada have high speed connectivity and 24% use low speed dial-up options (2005)

Canada is Canada is connectedconnected

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Cost

$148 billion business

10.4% of GDP

65% of costs for hospitals, physicians and drugs

Financing70% public funding30% private funding, primarily for drugs, dental and co-pay servicesMost privately provided health care services (e.g. physicians, laboratories, diagnostic imaging) are publicly funded

Health care is Health care is universally universally availableavailable

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Governance Governance through shared through shared accountabilityaccountability

Governance

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

900+ hospitals manage care

Approximately 400,000 health care professionals deliver care

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Health care driversHealth care drivers Pressure on the health system

Canada's population is aging fast

By 2011, an estimated 1.3 million Canadians will be over the age of 80

Senior citizens will outnumber children in about a decade

Health of baby boomers is declining

Health care spending is increasing

Wait times are a major issue

Political debates over private sector role in health care delivery

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Managing patient care in this complexityManaging patient care in this complexity

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• Accurate information that moves with them

• Communication between their various health care providers

• Protection of their privacy

• Input into decisions

• Elimination of undue risk

• Timely access/results

Great expectationsWhat Canadians expect from their health care system:

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The need for EHR

75 people will suffer an adverse drug event

20 people will suffer a serious drug event

90 people will suffer a serious adverse drug event

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

1,000 hospital admissions

1,000 patients with an ambulatory encounter

1,000 patients discharged from hospital

1,000 laboratory tests performed

370-430 are not vaccinated1,000 Canadians recommended for influenza protection

…in CanadaFor every…

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

1,000 emergency department visits

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The need for health information management

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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2.9

3.4

4.0

4.54.7

5.4

Education US HC providers

UK health care

Professional services

US banking/ financial services

Calgary Regional Health

Authority

1.5 – 2.0

HC IT spend Canadian

jurisdictions

Annual IT spendingPercentage 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.

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Improving the productivity of healthcare saves costs and makes optimal

use of available human and otherresources.

Reduced wait times

Benefits of EHRs

Improving quality improves health, reduces the burden on the system,

and ensures optimaluse of capacity.

Productivity• Provides time savings• Avoids unnecessary diagnostics, procedures and visits• Optimizes coordination of human resources

Productivity• Provides time savings• Avoids unnecessary diagnostics, procedures and visits• Optimizes coordination of human resources

Access• Timely delivery of care• Increased interpretations by remote specialists• Improved 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• Increased patient access and use of their health record

Quality• Better continuity of care improves disease and

case management • Appropriate care adheres to standards• Prevention of adverse events and public health threats

Quality• Better continuity of care improves disease and

case management • Appropriate care adheres to standards• Prevention of adverse events and public health threats

Capital cost : $10 billion to $12 billion Benefits: $6 billion to $7 billion in savings annually

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What is an EHR?

An electronic health record (EHR) is a secure and private lifetime record of an individual’s health and care history, available electronically to authorized health providers.

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Sample of an EHRResults and images Patient information Medical alerts

Medication history

Interactions

ImmunizationProblem list

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What Canadians think about EHRsAccording to a recent, independent survey:

• 88 per cent support electronic records

• Canadians believe electronic health records will enable health

care providers to deliver better quality care

• Increase effectiveness for doctors 87 per cent87 per cent

• Increase effectiveness for pharmacists 86 per cent86 per cent

• Increase effectiveness for nurses, patients 81 per cent81 per cent

and the health care system in general

* EKOS survey

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Infoway’s mission, approach, programs

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Canada Health Infoway• Canada 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

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 health care services.

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About InfowayOur 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

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InfowayInfoway adopted a unique strategic adopted a unique strategic investor roleinvestor role

Primary role

Secondary role

Canada

UK

Denmark

New Zealand

Kaiser

Veteran’s Affairs

Australia

Norway

Canada has a unique strategic investor

role that brings together a collaborative

engagement model, a shared

governance model, and a gated funding

approach

Invest, advise, and monitor

Work alongside and takeover if needed

Write code and build modules

Fund and ignore

Set direction and standards

Governor FunderStrategic investor

Intervener Developer

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Infoway business strategies

• Targeted investment programs

• Limited scope/goal

• Collaborate with health ministries and other partners

• Co-invest with public sector partners (75:25 formula)

• Leverage investment

• Form strategic alliances with the private sector

• Manage risk and ensure quality solutions

• Focus on end-user acceptance

• Measure benefits and adjust

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Infoway programs

Innovation and Adoption - $60 million*

Public Health Surveillance$135 million

Telehealth

$100 million

Innovation and Adoption – $60 million

Chronic DiseasesCancer

Primary Care Mental Health

Laboratory Systems$170 million

Diagnostic Imaging$340 million

Interoperable EHR – $365 million

Infostructure – $32 million

Registries$134 million

Drug Systems$250 million

Patient Access to Quality Care

$50 million

Architecture and Standards

Registries and Domain Repositories

The Electronic Health Record

Health care Applications and Innovation Projects

End-user Adoption and Setting the Future Direction

Ten investment programs totalling $1.636 billion

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Focus on standards and interoperability

• Common architecture largely accepted by jurisdictions

• Revised architecture includes privacy and security

• Comprehensive standards collaboration process

• New Infoway Standards Collaborative

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JURISDICTIONAL INFOSTRUCTURE

TerminologyRepository

Ancillary Data& Services

Registries Data& Services

EHR Data& Services

DataWarehouse

ImmunizationManagement

PHSReporting

SharedHealth Record

DrugInformation

DiagnosticImaging Laboratory Health

Information

EHR Viewer

Physician/Provider

BusinessRules

EHRIndex

MessageStructures

NormalizationRules

Security MgmtData Privacy Data Configuration

POINT OF SERVICE

Hospital, LTC,CCC, EPR

PhysicianOffice EMR

Physician/Provider

Physician/Provider

Lab System(LIS)

Lab Clinician

RadiologyCenter

PACS/RIS

Radiologist

PharmacySystem

Pharmacist

Public HealthServices

Public Health Provider

Longitudinal Record Services

HIAL Communication Bus

Common Services

ClientRegistry

ProviderRegistry

LocationRegistry

The EHR architecture

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Electronic health records: Linked jurisdiction networks

Distributed, message-based, peer-to-peer network of EHRS systems

EHRS EHRS EHRS EHRS EHRS EHRS EHRS

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Progress across Canada

29Registries Diagnostic Imaging Drug Info Systems Lab Info Systems Telehealth

Interoperable EHR Public Health Surveillance Innovation & Adoption Number of Projects

Summary of project activity

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245 active and completed projects with an estimated value of $1.332 billion as at Dec. 31, 2007

245 active and completed projects with an estimated value of $1.332 billion as at Dec. 31, 2007

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March 2004 = $125.2 million53 projects *

* Includes 27 pan-Canadian projects not shown

Implementation

Planning

Completed Projects

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** Includes 93 pan-Canadian projects not shown

Implementation

Planning

Completed Projects

December 2007 = $1.332 billion

245 projects **

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Leveraging EHR for innovative health care

Scarborough HospitalElectronic self-entry (by patients) of patient history in emergency department (ED) using touch-screen kiosks

Sherbourne Health CentreRemote electronic records for a Health Bus serving the inner city homeless

Vancouver Island Health AuthorityEHR-based clinical decision support tools to for Mental Health & Addictions Services

Sault Ste MarieLink primary care providers and pharmacists to the EMR/EHR

Quebec MSSSElectronic patient evaluation and service planning solutions

EHREHR

Primary Health Care

Public Health Patient

Safety

Chronic Disease

CancerWait

Times

British Columbia Ministry of HealthNewfoundland & Labrador’s Eastern HealthPilots for province-wide adverse events reporting, analysis and management

Alberta Capital/Calgary Health RegionsExtend Alberta's iEHR and chronic disease management solutions to primary care teams

Cancer Care OntarioComputerized order entry and clinical decision support to benefit cancer patients

Grand River HospitalPatient portal will provide access to health information for cancer and renal patients

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The value to stakeholders

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EHR: Overall benefits & valueEHR: Overall benefits & value

ACCESS• 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

QUALITY

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

disease outbreaks

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

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Benefits evaluation planTo assess impact of Infoway investments in EHR solutions on health care quality, productivity and access

Impacts identified will be used to:

• Demonstrate value

• Advance further investments

• Encourage end user adoption

• Highlight necessary adjustments in investment

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InfowayInfoway benefit evaluation frameworkbenefit evaluation frameworkThe framework articulates the link between the systems in which Infowayinvests and the resulting benefits, providing a basis for measurement.

UserSatisfaction

CompetencyUser SatisfactionEase of Use

UseUse Behavior/PatternSelf 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

Based on the Delone & McLean IS Success Model

Service quality

Responsiveness

Informationquality

ContentAvailability

System quality

FunctionalityPerformanceSecurity

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Good news for the Canadian economyInvestment in EHR is not a drain on government treasuries

• Direct and indirect investments

• Tax revenue

• Domestic industry development

• According to one recent study, EHR activity will create 37,000 jobs by 2010 or the equivalent of $2 billion in new labour income for Canadians

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Value to patients

• Diagnostic imaging

• Drug information systems

• Chronic care

• Elimination of undue risk

Value to jurisdictions/ governments• Cost avoidance

• Quality

• Access

• Sustainability

• Health reform success

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Value to health care professionalsImprove clinical decision-making• Deliver information at the right place at the right time

• Promote prevention, screening and better disease management

• Help manage knowledge complexity and promote evidence-based medicine

• Provide enhanced diagnostic capabilities through digital imaging

Enhance efficiency• Use appointment and scheduling systems to enhance workflow

• Improve nurses’ efficiency with clinical documentation

• Reduce need for filing, transcribing, phone calls photocopies

Facilitate communication• Show electronic records and digital images to patients to facilitate understanding

• Communication across the care team and the continuum of care

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Implications for physiciansImplications for physiciansInfoway does not:

• Purchase hardware/software for physician offices

• Offer consulting services to help acquire or implement office systems

But, Infoway does assist physicians by:

• Developing standards for IT (the architecture)

• Coordinating investment in the primary IT building blocks

• Collaborating on privacy/security issues

• Advancing an end-user acceptance strategy

» Encouraging jurisdictions to invest

» Working with physician organizations

» Physician advisory group

» Facilitating development of peer support networks

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Facilitating change through clinician Facilitating change through clinician ee--Health support networks [Health support networks [CeHSNCeHSN]]

Establish strong, supported networks of EHR/EMR/EPR peer leaders distributed across Canada to accelerate use of electronic health record solutions through peer leader support

Peer leaders include physicians, nurses and pharmacists

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Objectives of Objectives of CeHSNCeHSNSupport peers (physicians, pharmacists, nurses) in the use of technology within their practice settings and by integrating it into clinical work processes

Identify common and unique barriers and exchange advice on the application of health care technology solutions

Share best practices and build new knowledge

Communicate stories that demonstrate accelerated uptake within/between regional networks and professional groups

Collaborate with Infoway to enable an environment that accelerates the adoption and integration of information technology toward improving clinical care outcomes, access to information and improved productivity

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Lessons that are paying off

• Joint governance

• Joint planning

• Predictable funding

• Common solutions architecture

• Common ICT standards

• Accountable spend

• Common procurement

• Common solutions

• National pricing

• Shared services

• Knowledge sharing

• Global leaders exporting expertise

A mid-term independent performance evaluation conducted in 2005 and a 2006 review commissioned by Health Canada both validated and supported Infoway’s value-added role.

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On the road to 2015On the road to 2015

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Addi

tion

al E

lem

ents

Foun

dati

onal

Ele

men

ts

Implement electronic medical records in physician offices and physician order entry systems in hospitals

Enable public visibility for wait times and access

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Facilitate patient self-care and empowerment4

Trial and perfect more advanced functionality in wait times and chronic disease management

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Finish what started in electronic health records and public health surveillance

1Largest investment required

Priorities to 2015 Priorities to 2015

2

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Challenges and opportunities

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Physician office automation

Clinician adoption

Remote and first nations communities

Jurisdictional capacity

Standards

Interoperability and vendors

Patient engagement

Further capitalization

Public impatience

“If you think that an electronic health record is an essential backbone of any modern health care system, then [2015 is] far too long to wait.”

Steven Lewis, Health Council of Canada, October 7, 2007

Challenges to overcomeChallenges to overcome

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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

• Reduced wait times

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Thank you!