As mentioned in yesterday’s blog post I attended an eHealth Ontario vendor information system hosted by ITAC Ontario on July 26th in Toronto. Greg Reed, eHealth Ontario CEO, opened the presentation with a brief summary of notable agency accomplishments, including:
- 7,000 out of 10,000 physicians are adopting EMRs.
- An increasing number of physician offices are receiving data in electronic from (e.g discharge summaries) from hospitals through a number of initiatives.
- 100 hospitals have digital imaging and exchange capability with more coming online.
- 2,400 out of 3,000 head trauma pts not transferred from smaller hospitals to larger hospitals based on specialist recommendations provided through the Emergency Neurosurgery Image Transfer System.
The main portion of the presentation was delivered by Fariba Rawhani, VP, Architecture and Planning. She unveiled the eHealth Ontario 2015 Blueprint to a sold out room of health IT vendors. Ms. Rawhani did an admirable job, in my view, of putting the various elements of the blueprint into perspective and highlighting what she felt were the core themes of the blueprint. Overall I found her engaging and interesting. HOWEVER, I did, for the following reasons, take exception to her plea that the audience bear with her as the material might be a little dry:
- It is the presenter’s job to make the material interesting.
- There was a roomful of people who paid to hear about the latest developments at eHealth Ontario and who have been waiting a long time to hear about a new strategy. I watched many people furiously scribbling notes … clearly the material was far from dry for them!
- Implied that architecture / technical information of this nature is necessarily dry. Why do many senior executives seem to put down technical information in this way?
My main takeaways from this presentation include:
- Blueprint was developed after extensive consultation with a wide variety of stakeholders and is aligned with the Canada Health Infoway blueprint.
- Blueprint takes into account the reality that 80% of healthcare is delivered at the community level.
- Blueprint balances local discretion with shared direction. It is intended to be thoroughly planned, not thoroughly prescriptive.
- EHR 2015 is a journey, not a destination.
- The blueprint:
- provides a framework for collaboration
- defines the scope of EHR (eHealth Ontario plans to have a foundation in place by 2015 but won’t try to “boil the ocean”)
- specifies a federated approach to creation
- establishes governance that will lead to higher probability of successful delivery
- defines a standards-based architecture which eHealth Ontario hopes will become an open platform for innovation
- will reduce duplicated / wasted investments and increase speed of deployment
- enables operational high availability
- Health data is collected and stored at the organization level such that we have a fragments of patient data scattered across multiple facilities that cannot be easily assembled into a consistent, aggregate electronic health record.
- There is a significant investment in “legacy” systems that in many cases meet the needs of the organizations and users that they serve.
- The main theme of the blueprint is “connectivity”. eHealth Ontario believes that a major problem facing Ontario is not lack of data in digital form but an inability to share that information among healthcare providers. They want to create the “Interac” for health care information.
- Assembling a composite patient record by retrieving information directly from the collection of heterogeneous point of care systems is impractical. Hence, the EHR architecture described in the blueprint is based on central registries and repositories.
Key design principles influencing the EHR architecture:
Assure security and privacy
Accessible to those who need it in a timely manner
Four distinct categories addressed by the blueprint:
Connectivity and integration
The architectural vision is to
Foster an ecosystem in which many partners can innovate and share services and capabilities.
Enable clinicians, citizens, EHR, and healthcare facilities
The EHR architecture specified in the blueprint consists of three layers:
Point of Service applications (generally supplied by health IT vendors)
eHealth hub services (layer at which eHealth Ontario expects that most innovation will occur)
- Provincial eHealth services
- The eHealth hub services will be deployed at three regional hubs plus a provincial hub. The regional hubs serve:
- Northeastern Ontario (23% of the population)
- Southwestern Ontario (29% of the population)
- GTA (48% of the population)
- Many EHR related initiatives will take place at the regional hub level and will be driven by leaders at this level. eHealth Ontario will provide funding and resources and delegate the required authority.
- Privacy was mentioned several times during the presentation as a critically important consideration. Key elements of the eHealth Ontario Provincial Privacy Program include:
- privacy by design
- training and education
- eHealth Ontario feels that governance is a critical success factor and that governance and privacy, if done correctly, can be accelerators
- Data exchange / interoperability will be achieved through adherence to standards. To the extent possible, preference will be given to international standards. eHealth Ontario recognizes that the more global the focus, the more attractive Ontario will be as a place for vendors to innovate.
- eHealth Ontario support includes:
- Capacity building
- Other mechanisms as required
- Key eHealth Ontario led initiatives include:
- Logical architecture
- EHR asset inventory
- EHR roadmap
- Communication and training
Not surprisingly, I was pleased to hear several references to a healthcare ecosystem and an emphasis on innovation fostered by standards. The architecture appears to allow providers to continue to choose Point of Service applications that meet their particular needs and to allow vendors to continue to innovate at this level.
eHealth Ontario stated that they were still tinkering with the blueprint but hoped to have a 100+ page document release “very soon”. I look forward to reading all the details and engaging in discussions with my many readers and contacts.