HINZ | Presentation by Trevor Hodge | Senior Vice President, Canada Health Infoway | October 30, 2007

1. National eHealth Initiatives Effecting Change for Better Outcomes HINZ | Presentation by Trevor Hodge | Senior Vice President, Canada Health Infoway | October 30, 2007

4. National eHealth Initiatives Who are the Leaders On the world stage both New Zealand and Canada are definitely seen as leaders in ehealth!

8. National eHealth Initiatives Electronic Health Records – the Vision An electronic health record is a secure and private lifetime record of an individual’s health and care history, available electronically to authorized health providers. … . To date the global focus has been on automating paper records, a first step in modernizing healthcare

10. National eHealth Initiatives Electronic Health Records – the Technologies Enablers The Foundation Generation 1 Functionality and Value Chain Optimization Includes investments to support project management, user-adoption, change management, knowledge transfer, standards and benefits evaluation, representing 30% of program investments overall GARTNER Generation Model The Documenter Generation 2 The Helper Generation 3 The Mentor Generation 4

11. Gartner “Hype” Cycle Visibility Technology Trigger Peak of Inflated Expectation Trough of Disillusionment Slope of Enlightenment Plateau of Productivity Maturity

14. National eHealth Initiatives Electronic Health Records – Why was North America Different?

15. National eHealth Initiatives Electronic Health Records – The Evolution From Data Exchange To Data Sharing … . Data exchange works well up to a point, then it becomes too expensive to maintain and impossible to scale nationally

16. National eHealth Initiatives Electronic Health Records – The Evolution … . Regardless of the starting point or the path being currently taken we are all striving to reach the same end point …… an interoperable electronic health record

17. National eHealth Initiatives Electronic Health Records – the Evolution … . The evolution to an interoperable electronic health record is a major exercise in CHANGE

18. National eHealth Initiatives The Steps to Manage Change Kotter “ Leading Change ” Harvard Business Review

20. Advancing eHealth in Canada has been all about CHANGE

21. A Quick Snapshot Of Canada

45. Managing Information in This Complexity

47. Leadership

53. Approach

55. Approach – Investment Model

56. Approach – Investment Model

57. Approach – Investment Model $1,2 B in approved projects to date; 150 active projects with 20% in planning and 80% in implementation/adoption .…. A standard investment model reduced any debate about the total cost of a project and which costs were eligible for reimbursement

58. Approach – Investment Model .…. Gated Funding and 50% of the investment for system adoption introduced a new level of accountability for health IT projects Implementation Adoption 30% on Implementation gates 20% on contract signing 50% on adoption gates Approved Project Completed Project Infoway co-invests with jurisdictions at 75:25 of eligible project capital costs. Jurisdictions pay for the operating costs

60. Approach – Engagement Approach The Infoway Team .…. The culture of collaboration requires continual interaction and communication directed toward achieving a successful outcome ….. spiced with a little bit of humour

61. Approach – Engagement Approach …. But We Found it was a Rough World out There! Show me the money!! Why is it taking so long?!? What are you doing?!

62. .…. When we realized they weren’t really up on Monty Python we turned to football …. The North American variety Approach – Engagement Approach The Infoway Team

63. .…. So now its all about scoring touchdowns and celebrating success - together! Approach – Engagement Approach A Collaborative Culture

67. JURISDICTIONAL INFOSTRUCTURE POINT OF SERVICE Terminology Repository Ancillary Data & Services Registries Data & Services EHR Data & Services Data Warehouse Immunization Management PHS Reporting Shared Health Record Drug Information Diagnostic Imaging Laboratory Health Information Hospital, LTC, CCC, EPR Physician Office EMR EHR Viewer Physician/ Provider Business Rules EHR Index Message Structures Normalization Rules Security Mgmt Data Privacy Data Configuration Physician/ Provider Physician/ Provider Lab System (LIS) Lab Clinician Radiology Center PACS/RIS Radiologist Pharmacy System Pharmacist Public Health Services Public Health Provider Longitudinal Record Services HIAL Communication Bus Common Services Client Registry Provider Registry Location Registry Approach - Architecture

68. Approach – Architecture EHRS EHRS EHRS EHRS EHRS EHRS EHRS EHRS EHRS EHRS .…. Linked jurisdiction networks – a distributed, message-based, peer-to-peer network of ehealth systems across Caanda

70. Approach – Standards The Global Standoff .…. The Standards Challenge …. how do we get the USA and the major POS vendors to support the standards being implemented in the rest of the world … the next item on our Change Agenda HL7 v3 HL7 v2.x

71. Management

72.   Registries  Diagnostic Imaging  Drug Info Systems  Lab Info Systems  Telehealth  Interoperable EHR  Public Health Surveillance  Innovation & Adoption  Number of Projects                                                                                Management – Program Activity Results = Momentum  1 1

73. Management - Progress Across Canada .…. Public accountability regarding progress toward the national goal has placed pressure on jurisdictions to accelerate their efforts Forecasted Jurisdictional progress to March 31, 2008

75. Management – Procurement Aggregated Demand and Preferred Pricing Agreements .…. A major change in the way ehealth procurements were conducted in Canada resulting in significant financial benefits

78. Management – Change Management Primary Care Practices with Advanced Information Capacity * Count of 14: EMR, EMR access other doctors, outside office, patient; routine use electronic ordering tests, prescriptions, access test results, access hospital records; computer for reminders, Rx alerts, prompt tests results; easy to list diagnosis, medications, patients due for care. Percent reporting seven or more out of 14 functions* Source: 2006 Commonwealth Fund International Health Policy Survey of Primary Care Physicians. 72 8 32 59 87 83 19 0 25 50 75 100 AUS CAN GER NETH NZ UK US

79. Source: 2006 Commonwealth Fund International Health Policy Survey of Primary Care Physicians. Management – Change Management The Use of Teams and non-Physicians for the Chronically Ill 50 29 81 30 49 32 32 Yes Practice routinely uses clinicians other than doctors to: Practice routinely uses multidisciplinary teams: 39 70 51 33 56 22 38 Provide primary care services 73 UK 62 GER 57 NZ 36 46 25 38 Help manage patients with multiple chronic diseases US NETH CAN AUS

80. Management – Change Management Availability of Outcomes or Performance Data Source: 2006 Commonwealth Fund International Health Policy Survey of Primary Care Physicians. .…. Canada lags significantly in primary care …. this requires a major transformation effort, both clinical and administrative, that cannot be solved simply by implementing information technology 43 78 54 37 71 24 36 Patients’ clinical outcomes 89 UK 27 GER 33 NZ 48 16 11 29 Surveys of patient satisfaction and experiences US NETH CAN AUS Percent reporting yes:

85. Management – Privacy BRITISH COLUMBIA ALBERTA SASK MANITOBA ONTARIO QUEBEC NORTHWEST TERRITORIES NUNAVUT NEWFOUNDLAND & LABRADOR PEI NOVA SCOTIA NEW BRUNSWICK YUKON Legend PROVINCIAL PUBLIC SECTOR FREEDOM OF INFORMATION AND PRIVACY LAWS FEDERAL PUBLIC SECTOR ACCESS TO INFORMATION AND PRIVACY LAWS FEDERAL PRIVATE SECTOR PRIVACY LAW (“PIPEDA”) PROVINCIAL PRIVATE SECTOR PRIVACY LEGISLATION (“SUBSTAINTIALLY SIMILAR”) PROVINCIAL HEALTH INFORMATION PROTECTION LAW

88. Outcomes

89. What Constitutes Success The Infoway Mission

95. Key Findings: ON Drug Viewer Evaluation Improvements in Quality, Productivity and Satisfaction

96. Challenges

97. Tough times are ahead

100. And the change will continue as we increasingly try to effect bette r health outcomes

101. HINZ | Presentation by Trevor Hodge | Senior Vice President, Canada Health Infoway | October 30, 2007 [email_address] http://www.infoway-inforoute.ca/ Thank you!