Tracking disease

Health Canada is a step closer to establishing an electronic health record for every Canadian. The federal overseer of public health is adding disease outbreak tracking to i-PHIS, the data collection portion of the larger Canadian Integrated Public Health Surveillance project. “PHIS” stands for Public Health Information System; “i-” designates its shift from the original client server system to a Web-based application.

Calgary-based Pangaea Systems Inc. has won the contract, worth as much as $6 million, to add outbreak tracking to basic reporting. The Victoria branch of Pangaea created PHIS in 1994 for the British Columbia Centre for Disease Control (BCCDC). In 2000, Health Canada took over the intellectual property rights in return for a cash infusion to expand the case management application, which reports on communicable diseases, immunization and other public health concerns.

Public health deals with populations, not individual cases, says Ron Sussey, senior informatics advisor at Health Canada. “Every province looks at public health a little differently, but there is some consensus that it includes communicable disease, sexually transmitted disease, immunization and response to immunization. One province includes food inspection and water; another includes maternal-child (health), so it’s not consistent across the country.” Analyzing the collective data allows jurisdictions to know when to stockpile immunizations, for example, or hire more nurses.

Since 2002, i-PHIS has included client demographics, personal health services, communicable disease surveillance, laboratory test results, immunization tracking and scheduling, and disease outbreak reporting. The tracking function is to improve the analysis of such concerns as Clostridium difficile in Montreal, Sherbrooke and Calgary. The SARS outbreak in Toronto and Vancouver was a factor in going beyond reporting to tracking, said Tayo Runsewe, managing director of Pangaea’s B.C. Region.

“Because public health tends to be preventative, it is not on people’s radar until something goes wrong,” Runsewe said. “SARS helped get public health on the agenda. This (software) has significant health and financial ramifications.” Health Canada has been giving the software to provinces and territories in the hopes it can get all jurisdictions to sign on. The Canadian Integrated Public Health Surveillance (CIPHS) goal is to have a comprehensive, interoperable, pan-Canadian system for collecting, collating and disseminating detailed health care information quickly. That would allow for effective intervention during health events. Health Canada’s Centre for Surveillance Coordination office is overseeing CIPHS. A formal CIPHS collaborative organization, co-funded by the federal government and the provinces and territories, is to be in place by 2005. “We talk about systems and tools we need to build to make public health more integrated,” Sussey says. So far, the western provinces, Northwest Territories, Ontario and Newfoundland and Labrador are participating in i-PHIS. Each jurisdiction must pay for the enhancements it wants.

“As new requirements are presented by a jurisdiction, they are looked at by Health Canada to determine whether they should be added as core or as an enhancement for that jurisdiction,” Runsewe said. “The result is a rich feature set contributed to by all jurisdictions. “The system is designed to allow the collection of public health data as a byproduct of health professionals’ going about their day-to-day work, without requiring new systems or double entry. We bring in a technology layer that supports the business of health care rather than sitting over top and telling health care providers, ‘You will now do your business this way.’ “ Security for both transmission and level of authority meets standards set by Health Level Seven, a not-for-profit industry organization established specifically to determine protocols for managing medical data. It is based in Ann Arbor, Mich. “When we bring information into the electronic world, (privacy) gets a lot of focus because electronics makes access easier, (but) technology enables us to create more barriers than have historically existed,” Runsewe said.

“Data collected within a province is a provincial matter,” Sussey said. “That data could be used for many things; however, anyone who gets (access to) data has to have data-sharing agreements in place first. The idea is to (create) the system using standards so when we talk to other jurisdictions, everybody knows what we’re asking for. We don’t need to know identifiers. There’s not going to be any eye in the sky.”

Melanie Collison ( is a freelance journalist based in Calgary.

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