1. Canadian Perspective on an Interoperable EHR Medinfo September 8, 2004 Dennis Giokas Chief Technology Officer Canada Health Infoway Inc.

2. Todays 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 PE BC AB SK MB ON QC NB NS NL NU NT YT

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 Canadas 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. Infoways 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 Infoways 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. Infoways 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. Client, Provider and Location Registries Cross Program Components Innovation & Adoption Drug Information Systems Laboratory Information Systems Public Health Systems Telehealth Domain Repositories and Healthcare Applications Diagnostic Imaging Systems End user Adoption and Setting the Future Direction Interoperable EHR Infostructure The Electronic Health Record Architecture and Standards Nine Strategic Investment Programs - $60m $185m$150m$100m$150m$220m - $175m - $25m - $110m 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…. 202020022009 Pan-Canadian interoperable EHR Implementing EHR Building Blocks Five Application Areas Interoperable EHR using common Presentation Layer & key Blueprint Elements Target 50% of Canadas population 2009 Target/Focus All Application Areas incorporating full mentoring technology Interoperable EHR based on the fully standardized EHRS Blueprint Architecture Target 100% of Canadas population 2020 Target/Focus Conceptual EHRS Blueprint Getting there requires stepped improvement in applications developed, technology evolution, geographic coverage, standards coverage

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

11. Applications Appl EHRS Solution (EHRS) 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 EHR Data & Services EHR Repository Services Domain Repository Services Registry Services Communication Bus Common Services H I A L 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 Applications Appl Applications Clinical data to share is pushed from source systems into EHR in near real time EHR data is pulled into the providers application for one integrated view

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

13. Healthcare Providers View of EHR Applications Appl

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

15. Standards Development Principles Standards development will be done with the interests of Infoways 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. A Strong Focus on Re-Use & Interoperability Investing in Project Deliverables that can be Replicated or Reused Reuse drives down cost, accelerates timelines, reduces risk and enables interoperability. No solution Different specification Different standards Specification and standards Data model Business process Business rules User Interface Same solution Use shared service Least leverage Most leverage

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 Infoways 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 value is 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 in everything we do Healthcare community support and adoption are key to our success

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