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Learning Healthcare IT Lessons from North of the 49th Parallel

Lorraine Fernandes, RHIA, RHIT, for HealthLeaders Media, May 6, 2008

The U.S. is facing a crisis with the quality, disparity and cost of our healthcare services. We have a fragmented healthcare delivery system that functions with silos of data.

Creating a cohesive healthcare system is exactly what we need to meet the common objective of delivering high-quality, cost-effective, and timely patient care. Luckily, we have a model to follow directly to our north: Canada.

In Canada, the 14 federal, provincial and territorial Deputy Ministers of Health—as well as regional healthcare authorities and other healthcare organizations and information technology vendors and suppliers—are all working together toward a common goal: to provide 50% of Canadians with access to a secure electronic health record by 2010.

How does a country with more than 33 million people come to an agreement and move forward with a country-wide healthcare IT system? Easy—in Canada, the healthcare IT infrastructure functions like a business unit. To move forward with EHR adoption, this representative group did research, made a decision, secured funding, and began implementation.

Here in the U.S. we don’t make decisions nearly this quickly. We’ve been churning over patient identification, for example, for more than a decade. Churn costs money; churn costs development time and effectiveness; ultimately, churn costs lives. Let’s take a lesson from our northern neighbors and get the job done.

Following Canada’s lead
Spearheading the initiative is Canada Health Infoway, Inc., an independent not-for-profit organization that invests with public partners across Canada to implement and reuse compatible health information systems.

One of the first steps in implementing this nationwide project—and one of the most pivotal aspects of its success—was to create a common blueprint, or electronic health record “info-structure.”

This blueprint includes:

  • Client registry systems, similar to enterprise master person indexes and record locator services that commonly support regional health information organizations (RHIOs) in the U.S. domain repositories
  • A longitudinal record service, to coordinate data across multiple domains and registries
  • Standardized common services and communication services to sustain privacy, security and overall interoperability
  • Standardized information and message structures and standardized business transactions to support information exchange

In this model, each info-structure interoperates with others in a peer-to-peer manner through the Health Information Access Layer (HIAL). The data-sharing journey begins and ends with the HIAL.

Watch and learn
Let’s learn from Canada’s success and follow a business-model approach.

First, of course, let’s have a blueprint. Second, let’s invest wisely and strategically—and measure results to monitor that investment. The Canadian government invested $1.6 billion in the initiative. The government entities knew they needed to see value from their investment, so they funded a small number of targeted areas rather than spreading their investment across a range of initiatives.

The Canadian government also demands results. Each year, Infoway is accountable for reporting status and success metrics. Again, this mirrors the way a business unit would operate.

Third, no churning. Period. Let’s make decisions and start to move.

Ron G. Parker, Director of Architecture within the Solution Architecture Group at Infoway, added this advice: “It is important to invest in a structured collaboration model that ensures all key stakeholder communities are represented in the process of standardization.”

He explains that standardization of business processes in any industry requires a three-level simultaneous “sell”: To the executive decision makers/sponsors, to the people with the industry domain expertise, and to the people that implement the business processes directly.

“Only if everybody in this ‘stack’ knows the other groups are good-to-go, can you have success,” he says.

I love Canada. I just don’t want to move there. (In fact, I’d like to retire in Montana.) My hope is that we’ve got a nationwide healthcare IT system in place by that time. Needless to say, the clock is ticking. Can’t we follow someone else’s lead?


Lorraine Fernandes is VP, Healthcare Industry Ambassador at Initiate Systems. She frequently on topics such as RHIOs, health data exchange, patient identification issues, and best practices for master person index (MPI) cleanup. She serves on committees and workgroups for HIMSS, AHIMA, and Health Initiatives. She can be reached at lfernandes@initiatesystems.com.


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