A blueprint for success

The move toward a national system of electronic health record (EHR) solutions in Canada has taken a long step forward.

Canada Health Infoway (Infoway) – the independent corporation mandated by the federal, provincial and territorial governments to accelerate the development and implementation of electronic health information systems across the country – has released a first version of a national EHR solutions architectural blueprint.

The blueprint maps out the technological approaches and business considerations to help governments and health care delivery organizations in Canada develop and implement interoperable electronic health records.

Dennis Giokas, Infoway’s chief technology officer, and his solution architecture team were responsible for driving the blueprint project. During the first part of 2003, they consulted more than 300 stakeholders from the health care, academic and vendor communities. A reference group, comprised of representatives nominated by chief information officers from the provincial and territorial health ministries, was also involved.

“As a result, the blueprint truly reflects the collective thinking, the best ideas, the different viewpoints and priorities of a diverse group of experts,” Giokas said. “And most importantly, it ensures interoperability. That’s where our key focus is.”

Because most jurisdictions are in the various phases of EHR solution design and implementation, Giokas notes, there is an excellent opportunity to align approaches at the outset.

“As a starting point, we wanted to know as much as we could about the current environment,” he said. “What were the existing technical and business strategies across jurisdictions? What standards were planned or in place? What lessons learned and best practices have arisen from the design and implementation of solutions? The blueprint had to take into account the need for existing systems to integrate and interoperate with the new systems Infoway is investing in.”

For this reason, Giokas is quick to point out that the blueprint is not a rigid framework.

“Provinces, regions, and health care organizations have invested a great deal in technical infrastructures and applications, which were built to reflect and support specific business problems and processes and ways of doing business,” he said. “During our consultations, stakeholders were very clear that we needed to be extremely careful to protect these investments as much as possible.”

In order to build on these investments and extend the useful life of legacy systems, the blueprint is based on open standards and is neutral with respect to vendors and application providers. It does not advocate specific technologies but rather lays out the high-level specifications and structural properties necessary to ensure interoperability.

Giokas said it makes sound business sense for the health care sector in Canada to have an agreed-on road map for EHR solutions.

“Building EHR systems in isolation would be very costly, and what’s worse, there wouldn’t be any guarantee of interoperability down the road,” he said.

Infoway estimates that the one-time cost of building a national system of EHR solutions in isolation would be considerably greater than the approximately $2.5 billion it will cost with co-ordinated effort.

With the launch of the blueprint behind them, Giokas and his team are already working on the next iteration of the blueprint, which will address in more detail challenging issues related to interoperability, privacy and security from a technology standpoint.

“We need to drive down into more detailed design and specifications. We need to be more granular on how all of the services in the blueprint will work together, and we also need to make some technology choices to support those designs.”

The blueprint aims to accomplish this by defining interoperability profiles – storyboards of all the interactions in the system necessary to support the end user’s interactions with the system. In addition, the blueprint’s standards and guidelines will define the privacy-enhancing and information security technologies necessary to protect patient data from unwanted access, use and disclosure.

Infoway’s goal is to have the basic infrastructure and service components designed and deployed in 50 per cent of the country by mid-2006. This would enable electronic records to contain lab results, diagnostic imaging results, and prescription drug information.

In the meantime, Canada’s blueprint for an interoperable EHR is attracting international interest. The German government recently invited Giokas to present it to experts in health care IT.

Patrick Shaw (pshaw@infoway-inforoute.ca) is the acting group director of corporate affairs for Canada Health Infoway.

For more information visit:

Canada Health Infoway at www.canadahealthinfoway.ca. The full Infoway blueprint at http://knowledge.inforway-inforoute.ca.

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