Canadian Perspective on an Interoperable EHR Medinfo September 8, 2004

1. Canadian Perspective on anInteroperable EHRMedinfoSeptember 8, 2004 Dennis Giokas Chief Technology Officer Canada Health Infoway Inc.

2. Today’s Presentation • The Canadian Healthcare System • Introduction to Canada Health Infoway • Investment Strategy and Approach • Electronic Health Records Solution Architecture • Early Benefits of Our Approach

3. Overview of the Canadian Healthcare System • Publicly financed health care system that supports over 31 million people • Healthcare is delivered by 14 federal, provincial and territorial Plans with Federal funding support • The Plans are guided by 5 national principles set at the federal level • Public Administration • Comprehensiveness • Universality • Portability • Accessibility YT NT NU NL BC MB AB SK PE QC ON NS NB

4. Shared Accountability for Healthcare • The Provinces/Territories • Plan, finance, manage, evaluate health services • Provide public coverage for defined services (e.g. medical services, prescription drugs, dental care) for defined groups (seniors, children, welfare recipients) • The Federal government • Fulfills defined health functions: • Direct health service delivery to Veterans, native Canadians living on reserves, Military personnel, inmates of federal penitentiaries, and the Royal Canadian Mounted Police • Health protection, disease prevention, health promotion services • Funds are transferred from the federal government to provinces by direct block transfer based on funding formulas

5. Recognizing the Need for EHRs • Late 1990s • Growing F/P/T consensus on the need for interoperable electronic health record systems via Canada Health Infoway Report and pan-Canadian Health Infostructure Tactical Plan • September 2000 • Canada’s First Ministers unanimously agree “to work together to strengthen a Canada-wide health infostructure.” • Canada Health Infoway launched in late 2000 • Independent, not-for-profit corporation equally accountable to 14 F/P/T governments • $1.2B Capitalization since inception • $500M - Electronic Health Records focus (initial funding) • $600M - Accelerated EHR and Telehealth (March 2003) • $100M - Health Surveillance Systems (March 2004)

6. Infoway’s Mandate 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. To build on existing initiatives and pursue collaborative relationships in pursuit of its mission. Goal Infoway’s plan is to have an interoperable EHR in place across 50 percent of Canada by the end of 2009. Core Business We invest with public sector partners to develop, replicate and re-use compatible electronic health systems, thereby leveraging public funds, knowledge and results across Canada, to build a safer, more efficient healthcare system.

7. Infoway’s Investment Strategies • Targeted Programs • Focused on nine Investment Programs • Leveraged Investment • Invest in solutions that can be replicated in jurisdictions across the country • Collaboration with the Public Sector • Joint planning with health ministries and other partners • Joint Investments • Share the investment in projects with our public sector partners • Focus on End-Users • Early and on-going focus on end-users to gain acceptance and adoption • Alliances with the Private Sector • Form strategic alliances with private sector to implement standards-based, commercial solutions that reduce cost and risk • Measure Benefits and Adjust • Continually measure the benefits achieved against those planned and make the necessary adjustments

8. End user Adoption and Setting the Future Direction Innovation & Adoption The Electronic Health Record Interoperable EHR Drug Information Systems Laboratory Information Systems Diagnostic Imaging Systems Public Health Systems Domain Repositories and Healthcare Applications Telehealth Cross Program Components Client, Provider and Location Registries Architecture and Standards Infostructure Nine Strategic Investment Programs - $60m - $175m $185m $150m $220m $100m $150m - $110m - $25m Notes: (1) Includes investments to support project management, user-adoption, change management, knowledge transfer, standards and benefits evaluation, representing 30% of program investments (2) Will also require Jurisdictional Investment of $0.6-0.8B

9. Getting there over time…. Conceptual EHRS Blueprint 2002 2009 2020 Pan-Canadian interoperable EHR Implementing EHR Building Blocks 2009 Target/Focus 2020 Target/Focus • All Application Areas incorporating full “mentoring “ technology • Interoperable EHR based on the fully standardized EHRS Blueprint Architecture • Target 100% of Canada’s population • Five Application Areas • Interoperable EHR using common Presentation Layer & key Blueprint Elements • Target 50% of Canada’s population Getting there requires stepped improvement in applications developed, technology evolution, geographic coverage, standards coverage

10. Results to Date – Investments* • 63ongoing and completed projects in 10jurisdictions • $135 million in approved investments • Additional $200 million earmarked for specific projects but not yet signed * As of June 30, 2004

11. EHRS Solution (EHRS) EHR Data & Services DomainRepository Services EHR Repository Services Registry Services • Health Information Access Layer (HIAL) • Standards, common and communications services to integrate applications across the continuum of care and healthcare delivery jurisdictions • Enables integrated access and view • Most cost effective approach to integration Common Services H I A L Communication Bus Communication Bus Appl Appl Appl Appl Appl Appl Appl Appl Applications Applications • Applications • Clinical data to share is “pushed” from source systems into EHR in near real time • EHR data is “pulled” into the provider’s application for one integrated view Summary of Key EHRS Architecture Concepts • EHR • Patient-centric, womb to tomb • All clinically relevant data that needs to be shared • Encounter information • Structured, integrated and semantically consistent • Registries to identify people, providers and locations of care

12. EHRS Solution (EHRS) EHRS Solution (EHRS) EHR Infostructure (EHRi) EHR Infostructure (EHRi) EHR Data & Services EHR Data & Services EHR Repository Services EHR Repository Services DomainRepository Services DomainRepository Services Registry Services Registry Services Common Services Common Services H I A L H I A L Communication Bus Communication Bus Communication Bus Communication Bus Appl Appl Appl Appl Appl Appl Appl Appl Applications Applications EHRS EHRS EHRS EHRS EHRS EHRS EHRS EHR Solution Distributed, Message-based, Peer-to-Peer Network of EHRS Systems

13. Applications Appl Appl Healthcare Provider’s View of EHR

14. Larger Jurisdictions • Provincial Client and Provider Registries • Provincial Lab and Drug Repositories • Supra-regional EHR and DI Repositories • Local EMR, CIS and EHR viewer applications REGIONAL\JURISDICTIONAL Client Registry Client Registry Provider Registry Provider Registry EHR EHR DI Repository Drug Repository Laboratory Repository Laboratory Repository DI Repository Drug Repository DI Repository Region 1 Region 2 LOCAL/REGIONAL EMR CIS EMR EMR EMR CIS CIS CIS EHR Viewer Common Services Common Services EHR Viewer EHR Viewer EHR Viewer REGIONAL\JURISDICTIONAL Communication Bus Communication Bus Communication Bus Communication Bus HIAL HIAL • Smaller Jurisdictions • Provincial Client and Provider Registries • Provincial Lab, Drug, DI and EHR Repositories • Local EMR, CIS and EHR viewer applications LOCAL Results: Two Models Forming

15. Standards Development Principles • Standards development will be done with the interests of Infoway’s Members first and foremost • Driven by the benefits evaluation of our investments • Infoway will drive standards which are needed for the investment programs defined in the business plan • Standards efforts will follow the “influence, adopt, adapt, create” approach • Infoway funding for Standards work will be in the context of projects • Interoperability profiles define the integration architecture of the interoperable EHR with clinical systems

16. Investing in Project Deliverables that can be Replicated or Reused Least leverage Mostleverage Nosolution Businessrules Differentspecification Differentstandards Specification and standards Datamodel Businessprocess User Interface Samesolution Useshared service Reuse drives down cost, accelerates timelines, reduces risk and enables interoperability. A Strong Focus on Re-Use & Interoperability

17. Early Benefits of Collaborative Development • Aligning Strategies and Investments • Infoway and jurisdictions are well underway in aligning their strategies and investments toward implementing an interoperable electronic health record across 50% of Canada by the end of 2009 • Leveraging Investments • Jurisdictions have leveraged their investment dollars with Infoway’s • Replication and Re-use • Replication of client registry and provider registry solutions, as well as the DI shared-services model is driving economies of scale, cost-savings and accelerated deployment • Cost avoidance and knowledge transfer across jurisdictions through “How-to-Toolkits” enable faster project start-up • Benefiting from National Procurement Agreements • Provide favourable terms for the procurement of proven solutions • Implementing Standards-Based Solutions • Adopt, adapt or develop pan-Canadian standards • Increases interoperability & choice, while lowering overall cost

18. Summary • EHR systems are seen as key to a safer, cost-effective healthcare network • Interoperable EHRs in place across 50 percent of Canada by end of 2009 • Tangible valueis being delivered as we proceed, focused on • Registries • Diagnostic Imaging Systems • Drug Information Systems • Laboratory Information Systems • Telehealth • Public Health Surveillance • Interoperable Electronic Health Record • EHR securely integrates data from varied clinical information systems • Privacy is addressed ineverythingwe do • Healthcare community support and adoption are key to our success

19. Thank You! www.infoway-inforoute.ca dgiokas@infoway-inforoute.ca