ITAC Health's Alberta e-Health Consultation Breakfast Mark Brisson, Alberta Health and Wellness October 20, 2009

Proposed Agenda for Presentation Alberta's Health System – Context Provincial IM/IT Integrated Planning Focus –Example: Personal Health Portal Key Business and IM/IT Priorities

Alberta’s Health System - Context

Current Challenges in Alberta’s Health System > 35% of provincial spending and growing Dependence on hospital and nursing home care, yet limited community capacity Close proximity and limited capacity of small hospitals Health provider supply and productivity Little coordination/integration across the health system

An Elderly Diabetic and their interactions with the Healthcare System 8 Acute Care Legend: 1. Annual flu shot 2. Call HealthLink for advice 3. HealthLink refers to GP 4.Referral to Diabetes Education Centre 5. Referral to specialist 6. Referral to Ophthalmologist 7. Orders for diagnostics 8. Admission to acute care 9. Discharge medications 10.Home dialysis 11.Discharge care to GP 12.In-Home Care Client/Patient 2 HealthLink 5 Internist/ Endocrinologist 7 Diagnostic Services Public Health (flu) 1 3 Family Phys 4 Diabetes Education Centre Ophthalmologist Pharmacy 10 Home Dialysis Home Care 12

Drivers of Demand and Utilization Population growth and aging –Patients over the age of 65 drive 45% of annual growth. Average utilization of Alberta’s large acute care hospitals is 90% Over half of small hospitals have utilization below 75% Over 10% of all acute care beds are “blocked” by patients waiting for long term care or supportive living Chronic disease management

Health Spending - ( ) $12.9 billion $3 billion for physician services > $8 billion to Alberta Health Services (AHS) > $5 billion on staff salaries & benefits AHS spends $29.9 million per day If we continue at this rate of spending, AHS’s budget will grow by almost 200% by the year 2020

,000 15,000 20, ,000 Projected former RHA spending , baseline and optimal cases $ billions -6.2% -6.3% CONTROLLING COSTS WILL REQUIRE ALBERTA TO “BEND THE TREND” Source: AHW Economics Unit; Health & Wellness Business Plan; Year Projection assuming historical growth - base Projection assuming historical growth – optimistic scenario AHW Projections – base scenario AHW Projections – optimistic scenario

Where have we been… 120 hospital boards 17 regional health authorities 9 regional health authorities & 3 boards 1 centralized model: Alberta Health Services

Roles of AHW and AHS AHW Strategic/directional policy Macrosystem design Performance measurement Monitoring, compliance and assurance Funding Capital recommendations and approvals to Treasury Board AHS Service delivery Operational and workforce decisions Operational policies Allocation of funds to services Performance management Capital recommendations to AHW

Provincial IM/IT Integrated Planning Focus

Alberta “I-Plan” – An integrated IM/IT strategy that covers provincially-funded healthcare IM/IT investments Links overall business plans and strategies with detailed program/project plans Does set provincial strategic directions for healthcare IM/IT Includes specific progress/benefit measures that can be tracked to monitor execution of the Plan To provide an accountability framework for monitoring progress in executing the Plan. Is currently being finalized, with Health Information Executive Committee approval expected December 2009

I-Plan Scope Provincially-funded IM/IT initiatives undertaken by Alberta Health and Wellness, Alberta Health Services, Provider groups, or other organizations in major healthcare domains: –Point of service systems in hospitals and other healthcare delivery institutions (continuing care systems, public health systems); –Reference systems, provincial repositories and other components comprising an EHR infrastructure (registries, portal, pHIE); –Primary care and community medicine (e.g., EMRs); –Performance management and reporting systems

I-Plan Context Integrated I-Plan Vision 2020 Strategic Guidance Milestones, Metrics, benefits EHR/NetCare Strategy AHS IM/IT Strategy POSP Plan Access/WTM Strategy Pub Health IT Strategy EHR/NetCare Project Plans AHS IM/IT Project plans EMR Imp’n Plans Access/WTM Project plans Pub Health Project plans Operational / project plans Organizational tactical & strategic plans Personal Health Info Strategy PHP Project Plans Infrastructure Plans

Stakeholders Engaged in I-Plan Alberta Health and Wellness Business and IM/IT Division Alberta Health Services Clinical and IT Group Primary Care Initiative Physician Office System Program Alberta Medical Association College of Physicians and Surgeons of Alberta Alberta College of Pharmacists Alberta Continuing Care Association Alberta Pharmacists’ Association Primary Care Networks Office of the Information and Privacy Commissioner Canada Health Infoway

Provincial I-Plan Strategic Directions Achieving universal access by providers to a complete set of clinical data domains in the EHR Accelerating implementation of interoperable EMRs and other clinical management systems among independent providers Ensuring seamless flow of information across continuum of care Consolidation & standardization clinical business procedures, and supporting IM/IT Increasing personal access to health information

Example Initiative Description: Personal Health Portal DOMAIN DESCRIPTION: Personal Health Systems encompass all systems that grant patients access to clinical information. These systems allow patients to play an active role in partnering to manage their health and health care and provide them with information about themselves as well as the system in which they receive care. Patient portals are among the most common applications that can be used to fulfill this role and plans have already been developed to make his a reality in Alberta over the next 5 years. SCOPE STATEMENT: The Personal Health Portal (PHP) is envisioned to be an innovative (web-based and telephone service) application that will grant the public access to personalized information about wellness, health care, health conditions and treatments, health services, as well as many other health related aspects. TARGET STATE: The PHP will enable diverse health system providers to supply health content and services through the PHP framework, and assist in making the user experience as sea mless and coordinated as possible. Governance, standards, principles, and guidelines to support stakeholders in defining structures and content of the PHP will also be established. VALUE/BENEFITS (business language, not project-related) The PHP will enable Albertans to have improved ability to proactively manage their health and wellness, and access all health services that are available to them. Patients and clinicians will have the improved ability to communicate and interact with one another, and Patients can more effectively participate in managing their treatment. Patients will also be able to effectively engage the support of and assist others in their treatment.

Benefits / Clinical Value Benefits could be assessed based on potential savings in the following six categories: 1.Diabetes savings 2.Congestive Heart Failure (CHF) savings 3.Appointment Scheduling savings 4.E Visits savings 5.Medication Renewal savings 6.Pre-encounter Questionnaire savings

Key Business/Policy and IM/IT Priorities

Business / Policy Priorities Legislation to enable the delivery of health services using new models of care - MACH Building community capacity – Home Care, Aging in Place Creating a foundation of primary and public health Funding health providers for performance Implementing phase 2 of pharmaceutical strategy Proposing new approaches to funding health services

Key Project Focuses AHW Primary Provider Claims Reimbursement Pharmaceutical Information Network – e-Prescribing Performance Measurement / Data Warehousing / Health System Reporting Registry Integration and Development Health Workforce Forecasting AHW/AHS/AMA, etc..Joint EHR (Portal/pHIE) Deployment / Capability Enhancements Personal Health Portal Identity and Access Management Integration w/ AHS/Community Systems Continued Physician Automation Public Health Continuing Care Technologies