Power to the people

Designing and deploying a pan-Canadian health information system is a colossal, and challenging task – as the iPHIS project illustrates.

However, technology and project management are not the biggest challenges in extreme IT deployments, according to a veteran IT project director with the Canadian armed forces.

“In projects of this scope, people problems outweigh any other challenges you may have,” says Lt. Col. Jim Kirkland, a senior staff officer for health services informatics. “One you manage that, the rest is just mechanics.” Kirkland speaks from experience.

He heads up the Canadian Forces Health Information System (CFHIS) – one of the most comprehensive e-Health records programs in Canada.

CFHIS is designed to enhance everyday delivery of health care to this country’s armed forces.

Implemented in three phases at a total cost of Can $115 million, the project will enable more than 2,500 healthcare professionals in 80 clinics across Canada to secure information and coordinate the care of 85,000 regular and reserve force members.

“You need a heck of a lot of people to pull off something like this,” said Kirkland. The nearly 100 persons who helped get CFHIS off the ground included vendors, systems integrators, hardware/software providers, privacy and security consultants and more. Lockheed Martin was the chief systems integrator, Ottawa-based Dinmar Consulting offered the IS expertise, Purkinje Inc. from Montreal provided the core EHR application, while SCC Soft Computer Consultants, based in Tampa, Fla., contributed a suite of laboratory, radiology and pharmacy systems, with partner Calculus Informatique of Montreal ensuring they are all bilingual.

Other leading technology companies – Citrix, Compaq, IBM, Oracle and Entrust – were all involved in some way or other, in most cases providing enabling applications.

It was Kirkland’s job to ensure these diverse provider communities worked well together and came up with a system that delivered the goods.

The first phase of CFHIS has now been rolled out. In addition to the right people, planning, common standards and receptiveness to user feedback are other key pre-requisites for the success of mega IT projects, Kirkland says.

On the planning front, he said, his team spent two years mapping out an infrastructure management program for CFHIS. “That may seem a long time, but it paid off in spades.” As part of that plan, the project management team identified business processes to be supported by the system, looked at high-level data requirements, interface standards and security and confidentiality requirements, and even did a project profile and risk assessment. “This is unique, because outside of government hardly anybody does risk assessments,” said Kirkland.

Likewise, he said, a privacy expert was brought in to do a separate privacy assessment. Common standards are also vital – especially when the stakes are high and the stakeholders diverse.

“The problem in NATO – when you have different countries working together – is getting disparate medical management systems to talk to one other,” said Kirkland. He said common standards are the antidote. CIFHS, he said, complies with NATO standard requirements for reports and is consistent with the reference architecture adopted by ISO.

The use of standards, along with seamless co-ordination between applications, ensures vital information gets to the right people quickly and accurately. “Given the fast-paced nature of NATO operations this is vital,” said Kirkland. “Previously, when someone was injured we used to write the details on his chest and send him on for treatment. Now physicians need to know the ‘where’ and ‘how’ and a lot of other information…and they need it quickly.”

In CIFHS, ancillary applications work through an interface engine to a core clinical application that allows clinical notes to be created in an electronic format. So order entry (electronically ordering medication or lab tests) and results reporting are a snap. This rapid flow of critical information has contributed to the spectacular response to the CFHIS project.

“We surveyed the (health care provider) partners we deliver services to,” said Kirkland. “They are thrilled. In fact, someone jokingly threatened me with bodily harm if we take away the solution from their clinic.” Acceptance from the user community is the biggest triumph of any e-health project.

According to Kirkland, user acceptance of EHRs hinges on certain capabilities being readily available – such as the ability to do electronic order entry, results reporting and organization/presentation of data. “In other words unless your solution is quick, accurate and does not impede the care process, the guys will walk away from it.”

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