Canada Health Infoway won special recognition in Healthcare in our SOA Case Study contest. Here is a snapshot of their story, created by excerpting the contest submission. The groupings and emphasis are mine.
Organization
Canada Health Infoway is an independent, not-for-profit organization funded by the federal government that jointly invests with every province and territory to accelerate the development and adoption of electronic health record projects in Canada.
Business Scenario
Nationwide Electronic Health Records: The Canada Health Infoway’s (Infoway) mandate was to develop an architecture to support an Interoperable Electronic Health Record (iEHR). They define it as: “The iEHR provides each individual in Canada with a secure and private lifetime record of their key health history and care within the health system. The record is available electronically to authorized health providers and the individual anywhere, anytime in support of high quality care. This record is designed to facilitate the sharing of data across the continuum of care, across health care delivery organizations and across geographies.”
The iEHR is designed to be a reliable, authoritative, private, secure, and highly available set of databases of clinical information that is sourced from the clinical point of service.
Scope: They estimated that once the Canadian healthcare system is fully IT enabled there may be as many as 40,000 point of service (PoS) systems which will be connected to the iEHR. These systems support a very diverse set of users and clinical settings. This is further complicated by the fact that each of these settings and/or users are independent businesses or organizational entities. High quality, safe and efficient healthcare requires that the clinical data for a patient be shared among authorized clinicians.
Federated records: The final major requirement they had was to interconnect each of the jurisdictional systems into one seamless, federated set of EHR Solutions. By creating this connectivity, a resident in Canada will have a complete clinical record regardless of where they got care in the country. Their record will “follow them” if they move within the country as well. Finally, for something like public health surveillance, it is an imperative to have interoperability across the country to detect and manage an infectious disease pandemic.
ROI
Agility: The architecture was developed with a few key principles in mind from agility to support the evolving nature of healthcare delivery, to hard financial benefits. The architecture has been adopted by all of the jurisdictions in Canada.
Savings & Cost Avoidance: An independent study of the cost benefits of the HIAL and iEHR was done for Infoway by Booz Allen Hamilton. They estimated that the total cost of IT enabling the healthcare system to be $9.9B. The annual benefits (savings or cost avoidance in healthcare services) are estimated at $6.1B and to be $82.4B over 20 years.
Project Organization
Industry Subject Matter Experts: They had a core team of staff architects and standards experts that were part of the Solution Architecture Group at Infoway. Other core team members were from other departments including project managers, change management specialists and knowledge management specialists. This team was supplemented by contract subject matter experts that ranged from clinical experts (e.g. physicians, nurses, pharmacists) to technical experts in various areas (e.g. HL7, privacy and security).
Lessons
Infoway is currently addressing these shortcomings: (Service Design) They are creating more detailed implementation guides and specifications for the critical services that need to be defined and exposed in a common way across the country. They are also in the midst of defining their conformance strategy whereby these services, and other aspects of systems interoperability such as HL7 messaging and the use of controlled medical vocabularies, can be tested for compliance to the specifications and certified.
If they were to do this again, they would have worked more closely with the jurisdictions and their vendor partners to define these guidelines and specifications early on. This would have been followed up by consultations to build consensus on the solution definition.
FYI there's an important discussion going on about these issues that ends
TONIGHT:
www.thenationaldialogue.org
It's called the National Dialogue on Health IT & Privacy. On the site, you
can contribute ideas, and read and rate others' ideas. Watch in real time as
the best ideas "rise to the top."
** The results of this online dialogue are being compiled into a report to
the Federal CIO Council, Office of Management and Budget, and the incoming
Administration by the National Academy of Public Administrators. **
Please come join us! Make sure your voice gets heard, and included in the
report, which will help shape America's Health IT policy.
Maggie, The National Dialogue
Posted by: National Dialogue | November 03, 2008 at 01:46 PM