Fighting Fragmentation

Technology fragmentation and lack of a common IT infrastructure have dogged the Canadian health care sector for some time. But government and the private sector can join forces to tackle this problem – as recent initiatives in Ontario and Alberta demonstrate.

A great example of this collaboration is the infrastructure project spearheaded by Ontario’s Smart Systems for Health Agency (SSHA), in tandem with private sector technology firms.

SSHA is an Ontario government agency with a mandate to create a province-wide IT infrastructure for electronic communication among the province’s health service providers.

Fighting fragmentation in IT was a key objective of its infrastructure project, which many observers consider a near textbook example of successful public-private sector cooperation. (SSHA won a Diamond Award for the project at this year’s Showcase Ontario).

The infrastructure was designed and created by a team of SSHA systems architects who worked closely with more than 80 vendors, systems integrators and contractors. The design and build process was launched in 2001 and lasted around two years.

Major components of the SSHA infrastructure have already gone live. These include a common network, the messaging system, a state-of-the-art hosting environment, robust security and easy interfaces to an online portal-type infrastructure.

Linda Weaver, chief technology officer, SSHA, emphasizes the significance of what her agency has accomplished. “Health care organizations here have been building IT systems on a wing and a prayer,” she said. “With very little capital and no central command and control centre, we’ve had disjointed pockets of IT scattered all over the place. That was the nature of the beast.”

Until recently.

With SSHA’s infrastructure initiative, all that is changing. The project will eventually seamlessly link all hospitals and health care providers in Ontario. “About 25 per cent of our budget has been spent on connectivity,” Weaver said. The agency has connected 80 per cent of the province’s hospitals, and will soon link the remaining 20 per cent. This year, it also plans to begin linking the province’s 26,000 physicians, residents and medical students, along with up to 5,500 community care workers. Creating a common IT infrastructure using multi-vendor solutions in areas such as network, messaging, hosting, security and portals can be a daunting task.

According to Weaver, it was also a project filled with challenges and unexpected twists and turns. “We had to be alert enough to recognize when something was not working and flexible enough to change course when required.” The agency had to ensure that multiple solutions from vendors such as EDS, EMS, Entrust, Microsoft, StorageTek, HP Canada, Bell and Qunara worked seamlessly together. “EDS built systems inside HP data centres, linked them to Bell’s networks and collaborated with Qunara and Entrust on security. Very diverse systems needed to be cobbled together and the individual vendors, with their specialized expertise, were not equipped to do that.” So SSHA hired experienced systems integrators to do the knitting between solutions.

“From our point of view it was a significant learning,” said Weaver. “We realized contract managers alone would never get the job done. They may oversee the business relationship. But in any multi-vendor project of this scope, what’s needed is also a very strong technical integration team.” And that team appears to be delivering; one of its earliest triumphs was the creation of a fail-safe, robust and highly available messaging system capable of supporting 150,000 users. Connecting health care IT can also affect the level of patient care provided by practitioners.

This has certainly happened in the case of netCARE – Canada’s first major electronic health record (EHR) recently launched in Edmonton by Capital Health Authority, one of the country’s largest health systems. Like the SSHA infrastructure – but at a different scale and level – netCARE epitomizes successful public-private sector partnership. It was designed by Central Station, a consortium of five technology companies – Sierra Systems, Oracle International, Orion, Quovadx and HP Canada.

Capital Health’s first e-health initiative in partnership with private companies, netCARE links existing patient information systems across more than 30 area hospitals, clinics and health care facilities. “We’re talking about access to more than 5.5 million patient records,” said Dawna Freeman, regional manager of public affairs at Capital Health. netCARE, she said, functions as a user friendly, password protected Web portal that allows these records to be shared electronically between authorized health care providers. “This leads to better decisions at the point of care, and better continuity of care from one provider to another.”

Capital Health officials say netCARE fulfills a Romanow Commission ideal articulated two years ago. “Electronic health records,” the Commission observed, “are one of the keys to modernizing the health care system.” With the netCARE launch, that key is now available to physicians and health care practitioners across Edmonton.

One of them is Dr. Noel Gibney, a physician attached to the intensive care unit at the University of Alberta Hospital. “Many of our patients are too sick and their families too distressed to remember specifics about their medical information,” said Gibney. “In addition, many patients are unconscious or unaccompanied when they arrive. In those situations we’ve used netCARE to access critical information that otherwise may have taken hours to arrive.” Instantaneous access to such information on the netCARE physician portal has dramatically boosted efficiency and reduced costs, according to Donna Strating, CIO of Capital Health. “We’re hearing about doctors not ordering tests (which) they would otherwise have ordered and of physicians not performing surgeries after learning their patient had the same procedure done a few years ago.”

All this, she said, translates into better service, greater patient satisfaction, lower patient re-admission rates and cost savings. “It’s difficult to put a dollar value on the savings, but they are significant.”

According to Strating, the process of designing and building netCARE was almost as unique as the product itself. “And that process hasn’t ended.” Each of the technology partners, she said, played a pivotal role in creating a system that’s seamless, secure and user-friendly. “While Sierra project-managed the portal development, Orion helped design the user interface and Quovadx mapped the client registry to the portal. So if a patient registers at one location their data can be retrieved at any other facility. It does not have to be re-entered.” Strating said the Oracle database environment aggregates information from the city’s multiple medical record systems. “Linking to individual systems would be a lot of more work. Besides it would be risky, because each time we unplugged a system, it would adversely impact the portal. The database ensures information integrity and reliability of response times.”

The HP database platform, Strating said, provides required levels of security, speed and connectivity. HP Canada and telecom firm Telus will also be Capital Health’s partners in another soon-to-be-launched project: a Patient Access Portal.

“The Patient Access Portal will be another window into netCARE,” said Strating. “Patients will have access to select pieces of information that empower them to actively participate in their own health care management.” Child immunization records or lab test values – such as cholesterol levels – are examples of data that may be available via the Patient Portal. Capital Health plans to offer patients secure access to this information online and via the telephone.

From a security perspective, the netCARE portal will draw on the resources of Telus’ Information Protection Centre (IPC), according to Kal Ruberg, Vice-President of the E-Health Practice at Telus. Ruberg said the IPC provides consulting advice on secure processes and technologies for protecting sensitive information “We look at intrusion detection, patterns of intrusion and spam reduction within e-mail systems. All those capabilities will be brought to bear on Capital Health’s EHR environment.”

According to Ruberg, one project in the works is the creation of a site that helps diabetics to monitor and manage insulin dosage, diet and activity level. “We’re also working with Orion to develop a more formal environment for diabetes management, where physicians and patients can access clinical readings.”

Joaquim P. Menezes ([email protected]) is assistant editor of CIO Government Review.

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