Investing in BC eHealth

1. Investing in BC eHealth Diagnostic Accreditation Program Conference |Presentation by Jim Mickelson, Executive Director – Western Canada| Canada Health Infoway | May 12, 2008

2. Gartner “Hype” Cycle Visibility Technology Trigger Peak of Inflated Expectation Trough of Disillusionment Slope of Enlightenment Plateau of Productivity Maturity

3. Computers make it easier to do a lot of things, but most of the things they make it easier to do don't need to be done.- Andy Rooney

4. Gartner “Hype” Cycle Visibility Technology Trigger Peak of Inflated Expectation Trough of Disillusionment Slope of Enlightenment Plateau of Productivity Maturity

5. I have not failed. I've just found 10,000 ways that won't work.- Thomas Edison

6. <<Province X>> to develop information network --------------------------------------------------------------------------- The <<Province X>> government has signed a 5-year contract with <<Company y>>. for the development of a health-information network that will link authorized professionals across the province and provide fast access to patient information such as prescriptions, treatment and immunization history, and laboratory and x-ray results. The government believes the $100-million cost of the computer system will be recovered quickly through increased efficiency, reduced health care fraud and the creation of new preventive-care programs. -CMAJ – June 1, 1996

9. Infoway releases technology blueprint that will guide and accelerate the development of interoperable electronic health records in Canada Montreal, July 29, 2003 - Canada Health Infoway today released its electronic health record solution blueprint (EHRS Blueprint). The Blueprint is a fully validated, scalable business and technical architecture that will guide the development of EHR solutions in Canada. It represents a major milestone toward achieving Infoway's mission of accelerating the implementation of these systems in support of improved quality of care and patient safety.

10. The need for EHR in Canada 10

11. 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 11

12. Great expectations What Canadians expect from their health care system: • 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 EKOS survey of 2,000 Canadians, 2003 EKOS survey of 2,500 Canadians, 2004

13. Interoperability challenges 700 hospitals 40,000 general practitioners 315,000 nurses 29,000 specialists 26,000 pharmacists 1,600 long-term care facilities 13 13 13

14. 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

15. 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 healthcare providers and the individual anywhere, anytime in support of high quality care.

16. Access to detailed data Results and images Patient information Medical alerts Medication history Interactions Problem list Immunization

17. Improving the productivity of health Improving quality improves health, care saves costs and makes optimal use of available human and other resources. EHR: Overall benefits and value Capital cost: $10 billion to $12 billion Benefits: $6 billion to $7 billion in savings annually Quality • Better continuity of care improves disease and case management • Appropriate care adheres to standards • Prevention of adverse events and public health threats Productivity • Provides time savings • Avoids unnecessary diagnostics, procedures and visits • Optimizes coordination of human resources reduces the burden on the system, and ensures optimal use of capacity. 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 Reduced wait times

18. 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 healthcare system. Further, 50 per cent of Canadians will have their electronic health record readily available to their authorized professionals who provide their healthcare services.

19. Infoway programs Ten investment programs totalling $1.636 billion Innovation and Adoption – $60 million Innovation and Adoption - $60 million* Telehealth$100 million Public Health Surveillance $135 million Patient Access to Quality Care $50 million Cancer Chronic Diseases Primary Care Mental Health Interoperable EHR – $365 million Laboratory Systems $170 million Diagnostic Imaging $340 million Registries $134 million Drug Systems $250 million Infostructure – $32 million

20. Phase 0/1 Projects Phase 2 Projects System in place December 2007 = $1.332 billion 245 projects ** Approximately $150 million invested in BC ** Includes 93 pan-Canadian projects not shown

21. Domain Client Provider Jurisdiction PHS DI Drug Lab iEHR registry registry Status: Complete AB Adoption BC Implementation PE Planning SK Forecast NL MB ON NS QC NB NT YT NU Percent Deployed at Mar.31, 2008 71 30 7 0 29 64 24 Note: • “Percent Deployed” is the percent of the Canadian population covered by the solution • To depict both full and partial progress “Percent Deployed” is calculated as 100% of the jurisdiction population if the project is complete and 50% of the jurisdiction population if the project is in the adoption phase Jurisdictional Progress to March 31, 2008 Progress to date

22. British Columbia Investment Summary 22

23. Deciding on the RightInvestments

24. EHR Architecture

25. Infoway DI Investments in BC • Interior Health • Supported the completion of the regional PACS implementation and a single repository • Provincial • Plan being revised to align with provincial ehealth priorities • Fraser Health • One of Infoway’s first investments • Supported regional PACS implementation and a single repository

26. Key Findings: PACS Evaluations • Improvement in productivity • After one year of implementation, BC’s Fraser Health Authority had a 17% reduction in operating cost per exam in a PACS environment in comparison to a pure film environment, ($37/exam vs $44/exam) • 87% of Radiologists and 73% of Referring Physicians indicated that PACS has increased their reporting and consultation efficiency • Across BC’s Interior Health Authority project sites (n=22), average Report Turn Around Time decreased by 41%

27. Infoway Drug Investment in BC • eDrug • Builds on “All Drugs All People” repository of Pharmanet • Adds additional content (e.g. in-hospital medications) • Adds eprescribing

28. Infoway Lab Investment in BC • Provincial Lab Information System (PLIS) • Managed in conjunction with the BC iEHR project • Planned to be the first ehealth “clinical domain” deployed through the ehealth infostructure • Provides for a provincial lab repository

29. EHR Architecture

30. Infoway Registries Investment in BC • Provincial Client and Provider Registries • Provincial Client Registry to enable accurate identification of patients connected with their EHR data • Provincial Provider Registry enables accurate identification of providers and for them to be appropriately connected with EHR data

31. EHR Architecture

32. Infoway iEHR Investment in BC • Provincial EHR Infostructure • Enables sharing of EHR data from multiple domains • Enables appropriate privacy and security • Includes “Secure Health Record” – clinically relevant data not available in the drug, DI, and Lab repositories

33. Other Infoway Investment in BC • Public Health Surveillance • Panorama application implementation • Telehealth • Clinical expansion and First Nations telehealth expansion • Innovation and Adoption • Patient Safety and Learning System • Mental Health and Addictions Patient Flow

34. 2008–09 action plans Forecasted Progress to March 31, 2009 Domain Client Provider Jurisdiction PHS DI Drug Lab iEHR registry registry Status: Complete PE Adoption AB Implementation BC Planning SK Forecast NL QC MB NS NB ON NT YT NU Percent Deployed at Mar.31, 2009 76 51 28 33 63 79 59 Note: • “Percent Deployed” is the percent of the Canadian population covered by the solution • To depict both full and partial progress “Percent Deployed” is calculated as 100% of the jurisdiction population if the project is complete and 50% of the jurisdiction population if the project is in the adoption phase

35. 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 • Reduction in duplicate or unnecessary tests • Reduced wait times 35

37. Thank you! 37