eHealth: Contributing to health care quality, accessibility and productivity

1. eHealth: Contributing to health care quality, accessibility and productivity Sarah Muttitt , Vice-President, Innovation and Adoption, Canada Health Infoway October 30 2007

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

3. 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 • Population is aging • Consumerism is growing • Pressures on resources are greater • Care settings are shifting

5. Where are we today? • 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 79% Canada 23%

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

7. 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 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.

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

12. System quality Functionality Performance Security Information quality Content User Availability Satisfaction Competency Service User Satisfaction Ease of Use quality Responsiveness 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 Quality • Patient safety Use • Appropriateness/ effectiveness Use Behavior/ • Health outcomes Pattern Self Reported Use Intention to Use Access • Ability of patients/providers to access services • Patient and caregiver participation 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. Longitudinal Record Services Common Services Communication Bus JURISDICTIONAL INFOSTRUCTURE Ancillary Data& Services EHR Data& Services Registries Data& Services ImmunizationManagement PHSReporting SharedHealth Record DrugInformation DiagnosticImaging Laboratory ClientRegistry ProviderRegistry BusinessRules EHRIndex MessageStructures NormalizationRules TerminologyRepository LocationRegistry Security MgmtData Privacy Data Configuration HIAL Public HealthServices PharmacySystem RadiologyCenterPACS/RIS Lab System(LIS) Hospital, LTC,CCC, EPR PhysicianOffice EMR EHR Viewer Public Health Provider Pharmacist Radiologist Lab Clinician Physician/Provider Physician/Provider Physician/Provider POINT OF SERVICE 14 The EHR Blueprint DataWarehouse DataWarehouse • 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 HealthInformation HealthInformation

15. Thank you 15