Building Bridges Canada’s eHealth Initiative

1. Saskatoon 2010 Building BridgesCanada’s eHealth Initiative Trevor Hodge, Senior Vice President, Canada Health Infoway September 30, 2010

2. Agenda • Background • Vision 2015 • Infoway’s Investment Approach • Our Investments: • Electronic Health Record • EMR & Integration • Telehealth, • Consumer Health and • Public Health Surveillance • Public Education

3. National eHealth Initiatives 17 21 23 National EHR Emerging EHR Positioning to Emerge Australia, Canada, Denmark, Finland, Hong Kong, Israel, Netherlands, New Zealand, Norway, Saudi Arabia, Singapore, Spain, Sweden, Taiwan, UAE, U.K., U.S.A. Argentina, Austria, Belgium, Belize, Brazil, Czech Republic, Estonia, France, Germany, Iceland, Ireland, Italy, Japan, Lithuania, Luxembourg, Malaysia, Mexico, Slovakia, South Korea, Switzerland, Turkey Abu Dhabi, Bangladesh, Bulgaria, China, Columbia, Costa Rica, Croatia, Cyprus, Ecuador, Egypt, Greece, Hungary, India, Indonesia, Malta, Poland, Portugal, Puerto Rico, Qatar, Slovenia, South Africa, Thailand, The Philippines

4. Canada Health Infoway Created in 2001 as an independent not-for-profit corporation Accountable to 14 federal/provincial/territorial governments $2.1 billion in federal funding to date - $500 million in March 2010 as part of the Economic Action Plan Matching jurisdiction contributions account for 25 percent of eligible projects costs, plus on-going operations and maintenance • Leadership • National leadership, expertise and services to support the jurisdictions in their eHealth implementations • EHR Architectural Blueprint • pan-Canadian Standards • Strategic Investor • Co-invest with jurisdiction and private sector partners • Involved in project planning, risk management, deliverable quality and benefits realization • Gated funding approach 4

5. The Vision 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.

6. 1 Foundational Elements Finish what we have started in electronic health records, telehealth and public health surveillance 2 Implement electronic medical records in physician offices and physician order entry systems in hospitals 3 AdditionalElements Deploy Wait Time Management Solutions 4 Implement Consumer Health Solutions to support selfcare Integrate Chronic Disease Management Solutions, starting with diabetes 5 Common DirectionVision 2015 During 2006, Canada identified five health information and technology priorities for the next 10 years, namely

7. Vision 2015 Business Goals • Access – support consistent access to patient care • Availability of services; Ability to access services; Consumer participation • Quality – provide safer and improved quality of patient care • Safety, Appropriateness and effectiveness; Health outcomes • Productivity – more efficient use of health system resources • Efficiency; Care Coordination; Net cost The Business Case • Cost – $10 B to $12 B capital cost; $1.5 B to $1.7 B annual operating cost • Benefits – $6 B to $7 B annually

8. Vision 2015The Return on Investment Of the ~$6.0 billion annually(in 2007 dollars) Cost Avoidance &Capacity Creation Cost Reduction $5.2B benefit (86%) $0.8B benefit (14%) Quality Access Productivity • Cost Avoidance/Capacity benefits => reduction in medication errors and adverse drug events; improvements in radiology productivity • Cost Reduction benefits => and reductions in laboratory and diagnostic imaging tests and diagnostic imaging film/space costs Source: Defining a path forward for Canada’s health infostructure – Final Report (McKinsey).

9. Lab Drug 69% 27% DI Vision 2015The Return on Investment Of the ~$6.0 billion annually Drug Self Care Current Scope 50% Wait Times 12% CDM DI Lab Outlook to 2015 Source: Defining a path forward for Canada’s health infostructure – Final Report (McKinsey).

10. 30% 60% Infoway Investments • ~ $2.1 B in 12 investment programs • Co-invest with jurisdictions, • 76% of funds approved and 45% expensed as at April 2010

11. Integrating Points of Care Homecare Emergency Services Clinic Community Care Centre Pharmacy Laboratory Specialist Clinic Hospital Emergency Diagnostic

12. Building Bridges

13. Electronic Health Records ~$1.3 B investment

14. Electronic Health RecordsClinical Value • Infoway Focus • Clinical use has been the primary focus rather than administrative use (e.g. billing) or secondary use (e.g. research and evaluation) • Clinical Value • Put/Get patient and provider demographics • Put/Get laboratory results, both as provider ordered results and a complete laboratory results profile • Put/Get prescriptions/renewals and a complete medication profile, including clinical decision support (e.g. drug-drug interactions) • Put/Get diagnostic imaging reports and images, both as provider ordered results and a complete diagnostic imaging profile • Put/Get immunization profile • Put/Get clinical reports (e.g. discharge summaries)

15. Electronic Health RecordsUSA Meaningful Use • diagnostic imaging • telehealth • public health • hCPOE • reporting • structured data (e.g. lab, drug) • clinical documents • e-prescribing • clinical decision support (i.e. DUR) • consumer health • health information exchange/sharing • privacy and security

16. Data, Applications and Services End-user Applications Technology Approach Used Today eCommerce Platform ITunes Music (data) End-UserDevices

17. Health DataApplications & Services End-user Applications Technology Approach Used Today eHealth Platform Electronic Health Record Electronic Medical Record Hospital Info. System etc End-UserDevices

18. Infoway Investment Approach • Common architecture accepted by jurisdictions and vendors • links local clinical systems with jurisdiction and regional registries and repositories using a data sharing approach • serves as a reference model for Infoway investments • Freely available on the Infoway website http://www.infoway-inforoute.ca

19. Common Services Communication Bus HIAL Longitudinal Record Services The End-State Blueprint JURISDICTIONAL INFOSTRUCTURE EHR Data& Services Registries Data& Services Laboratory DrugInformation DiagnosticImaging Shared Health Record ClientRegistry ProviderRegistry Public HealthServices PharmacySystem RadiologyCenterPACS/RIS Lab System(LIS) Hospital, LTC,CCC, EPR PhysicianOffice EMR EHR Viewer Patient Portal Public Health Provider Pharmacist Radiologist Lab Clinician Physician/Provider Physician/Provider Physician/Provider Public POINT OF SERVICE

20. Electronic Health Records

21. Electronic Health RecordsForecasted Progress to 2010 Goal Progress at March 31, 2010 to 2010 Goal = 22% Forecasted progress to December 31, 2010 Goal = 42% (as at August 2010)

22. Alberta Netcare – electronic health record • Demographic, diagnostic imaging, drug, laboratory and hospital data Users • Over 25,000 active users of the electronic health record • 40% of users are physicians (23%) and their office support staff (17%) • 28% of users are nurses Use • Lab results and transcribed reports • Medication profiles

23. Electronic Medical Records and Integration $340M investment (additional $40M for Adoption and Support)

24. Physician Use of Electronic Medical Records Percent Source: 2009 Commonwealth Fund International Health Policy Survey of Primary Care Physicians. Electronic Medical Records • Use is slowly increasing – 37% in 2009, up from 23% in 2006 and 14% in 2000 • However, still a major gap – a critical part of the architecture that is still at low levels of adoption and use in Canada • Progress in some jurisdictions – BC, AB, SK, MB, ON and NS have EMR implementation programs in place

25. Upgrade • existing clinical solutions • Electronic medical records • Community pharmacy systems • Connect hospital information systems Achieve increased clinical value Derive clinical value from the use of electronic medical records in community care settings Deploy more clinical solutions Implement upgraded electronic medical records in community and ambulatory settings EMR and Clinical Systems IntegrationThe Investment Focus ~35% ~65%

26. EMR & Integration Investment Approach • “Deploy and Achieve” targets jurisdictions • Bolster existing jurisdiction physician office system programs that fund physicians to implement an approved EMR system • Accelerate the establishment of physician office system programs in jurisdictions without one • Invest in adoption support (e.g. peer-to-peer networks) activities both locally and nationally • “Upgrade” targets jurisdictions and vendors • Invest with EMR vendors primarily to upgrade their solutions to an agreed-upon integration specification based on pan-Canadian standards • Jurisdictions are funded to deploy the upgraded EMR solutions; as well, Infoway will invest directly with jurisdictions to integrate EMR, hospital, and community pharmacy with their available EHR infostructure 26

27. EMR & Integration Investment Approach • Tailor the program to address the readiness of each jurisdiction; their approved vendors and the timing of their EMR upgrade process • Primary Users are physicians, both general practitioners and specialists (~50,000); Nurse Practitioners (~1,000); in physician offices, ambulatory (outpatient) clinics and health centres • Invest in EMRs for a target population of up to 12,000 eligible clinicians in community settings and up to 8,000 eligible concurrent users (seats) in ambulatory care settings • Co-invest with jurisdictions for a set fee of up to 50% of their cost to a ceiling based on the type of care setting

28. Electronic Medical RecordsAchieving Clinical Value • Infoway Focus • Increased clinical value and not administrative use (e.g. billing) • Increased clinical value is validated to ensure it is occurring • Infoway Clinical Value Criteria Level 1 • Enter encounter notes • Enter problem lists, allergies, immunizations and vitals • Enter new prescriptions/renewals into EMR, which can be printed • Generate automated alerts and reminders from within EMR • Receive laboratory results into the EMR • Infoway Clinical Value Criteria Level 2 • Clinician does e-prescribing and receives a complete medication history and automated medication alerts into the EMR

29. Telehealth $110 M investment

30. Remote Monitoring Teletriage Telehealth Device Deployment • The deployment of telehealth devices varies across Canada Teletriage and video-conferencing technologies are mature, while remote monitoring and pathology data rich image devices are emerging in their deployment

31. Ontario Telemedicine Network Profile • One of the largest telemedicine networks in the world using live, two-way videoconferencing systems and related diagnostic equipment. • Rapidly moving into remote monitoring and telepathology • Over 3,000 health care professionals delivering care • Services provided via 925 sites across the province • In 2009, over 90,000 patient visits in Ontario were conducted using telemedicine • Significant integration with First Nations communities

32. Independent federal & jurisdiction investment Telehealth Deployment in Aboriginal Communities • Through a mix of federal, jurisdiction and Infoway support, the majority of Canada’s first nation communities are telehealth-enabled. • The focus is aboriginal communities with health centres • Infoway will meet its target of 215 communities by December 31, 2010 and exceed that target into 2011.

33. Consumer Health Solutions $45 M investment

34. Consumer Health • Patient Portal Functionality • Find health information A-Z • Find provider, facility and service information • Communicate with healthcare providers • View health record • Manage medication refills • View wait times • Book appointments with family physicians • View who has looked at your health record • Patient Portal Integration • Physician offices • Community pharmacies • Hospitals • Private sector offerings

35. Public Health Surveillance $150 M investment

36. Public Health Surveillance - Panorama • Panorama solution has been built which is fully interoperable with the EHR infostructure • Functionality • Vaccine • Immunization • Investigations • Outbreak • Alerting • Reporting • Implementation phase • Quebec • British Columbia • Ontario • Nova Scotia • Newfoundland-Labrador • Saskatchewan • Manitoba

37. Public Education Campaign While the campaign aims to inform the opinions of all Canadians, the focus will be on those who are most likely to see the benefits of EHR systems: Patientsliving with chronic conditions – long-term, frequent users of the system Family Caregivers – women aged 40+ with children and are responsible for the health of their family Seniors – men or women aged 55+ who are facing health care challenges; frequent users of the system and who are interested in health policies

38. Campaign components The campaign will use TV, print, online and news media outreach, as well as an informational microsite, to inform Canadians about the benefits of EHR systems TV Print Knowingisbetter.ca Online Banners Knowing is Better than Not Knowing

39. Some Final Thoughts – on Building Bridges • Building Bridges … to think through healthcare and information technology as a country and not just as 14 individual healthcare systems • Building Bridges … to reach a common understanding of what information needs to be exchanged across care settings (the continuum of care) so we can achieve improved clinical value • Building Bridges … to those clinician communities who have been relatively slow to adopt technology • Building Bridges … to elected officials across Canada to obtain their continual commitment and support for a 10-15 year journey • Building Bridges … to the public to ensure so they understand what we are doing and the benefits that they will receive

40. Thank you