Privacy was maintained but the patient died ( oops !)

1. Privacy was maintained but the patient died (oops!) Access & Privacy Conference 2007 Edmonton, Alberta

2. Agenda • The vision re-visited • The privacy journey • Delivery of care objectives • What’s needed to move forward • Putting privacy into perspective • Discussion

3. The EHR is a secure & private lifetime record of an individual’s health and care history, available electronically to authorized health providers. It facilitates the sharing of data – across the continuum of care, across health care delivery organizations and across geographies. EHR vision re-visited

4. Putting it in delivery terms “ The ultimate goal is to enable access to health information from wherever you are. If you are from Montreal and break your leg skiing at Whistler, a doctor in Vancouver could access your record to make sure that he or she has information about the medications you are currently prescribed or any underlying medical conditions they need to be aware of.” Richard Alvarez President and CEO, Canada Health Infoway Globe & Mail, May 30, 2007

5. The privacy journey…one province’s story • 1996 • Current state assessment of Alberta’s health IM/IT infrastructure • 1997 • Start of Alberta’s EHR initiative • Start of consultations on provincial privacy legislation for health information • 2001 • Canada Health Infoway established • Alberta’s Health Information Act passed • Physician Office System Program established • 2003 • Agreement on Primary Care Initiative reached • 2005 • Pan-Canadian Health Information Privacy & Confidentiality Framework • POSP makes PIAs a ‘required’ service • 2007 • Infoway White Paper on Information Governance of the iEHR

6. Where we’re at in Alberta • Physicians • Approximately 90% compliance with PIA requirement • Regions/providers • Sharing information (lab, drugs and DI text) via Portal 2006 • Any physician can see any patient • Access audited • Primary care networks • Engaged in discussion re: what data is shared with whom • Inter-jurisdictional • Paper/phone on a patient-by-patient basis • Discussions re: increasing access underway

7. Delivery of care objectives • Link information at each point of service & make it available to that jurisdiction’s health providers • Capture data about the jurisdiction’s residents who receive care (e.g., lab tests, diagnosis, treatment) in another jurisdiction & make it available in the jurisdiction of residence • Allow clinicians access to non-residents’ health data from their ‘home’ jurisdiction

8. Link information at each point of service & make it available to that jurisdiction’s health providers Capture data about the jurisdiction’s residents who receive care in another jurisdiction & make it available in the jurisdiction of residence Allow clinicians access to non-residents’ health data from their ‘home’ jurisdiction √ X X What’s possible now

9. Inter-jurisdictional sharing • Provinces/territories beginning to look at cross-border scenarios • Providing electronic access to information re: out-of-jurisdiction services • One jurisdiction ‘hosting’ part of another’s EHR infrastructure • Multi-jurisdiction initiatives (e.g., public health) • Privacy commissioners not engaged at the build/delivery level • Issues are common but efforts not coordinated at the ‘build’ or project level; jurisdictions at different stages of development • Huge expenditure of resources, significant lapsed time

10. What’s needed? • Understanding at the political level • Deputy Minister support Resources! • Privacy Commissioners’ buy-in to the vision • Realistic & coordinated timelines • National coordination/sharing • Coordinated communication strategy with local customization • Clinician leadership at the architecture, design, development and delivery stages • Agreement on WHAT should be shared • Feedback mechanism to resolve issues/overcome barriers associated with real-world projects • Common sense

11. Impact on EHR agenda 5 Privacy breach System failure & data loss 4 Probability 3 2 1 1 2 3 4 5 Impact

12. Thank you! Mary Gibson Consulting Ph: (780) 466-2613 Email: mary@marygibsonconsulting.com Web: www.marygibsonconsulting.com