- Background: Canada Health Infoway, Inc. partners with the Canadian government to implement compatible health information systems that support a safer, more efficient healthcare system
- Challenge: Canadian provinces need a comprehensive EMPI as part of a client registry to help meet Infoway’s technology requirements for a national electronic health record (EHR) system.
- Solution: Eight provinces have chosen Initiate® software as the EMPI for their client registries
- Results: The eight provinces are achieving improved patient access to healthcare services, shorter wait times for diagnostic test results and improved registration processes while gaining a firm foundation for a national EHR.
Launched in 2001, Canada Health Infoway (Infoway) is an independent, not-for-profit organization whose members are Canada’s 14 federal, provincial and territorial Deputy Ministers of Health. As a strategic investor, Infoway works in partnership with the federal, provincial and territorial jurisdictions, regional healthcare authorities, other healthcare organisations and information technology vendors and suppliers to implement and reuse compatible health information systems that support a safer, more efficient healthcare system. One of Infoway’s nine targeted program areas is client registries, which Infoway sees as a key facet of the “blueprint” to achieve its ultimate goal: to enable every province and territory and the populations they serve to benefit from new health information systems (specifically, to provide 50 percent of Canadians with access to a secure electronic health record by 2010).
Challenge: Improve the Health of Patient Data
Blueprint for a Nationwide Master Person Index
From coast to coast to coast, Canada’s provinces faced a common challenge clearly recognized by Infoway – the need to have and share the most comprehensive, accessible and accurate view of the patient population across each province. Not only would this accessibility and accuracy immediately support the improvement of patient care, but would also be a firm foundation for future adoption of Canada’s national clinical initiatives, especially an EHR.
The provinces also had their own unique challenges in managing patient information. In Ontario, for example, citizens complained of long wait times for the delivery of healthcare services and diagnostic test results. The Ontario government recognized that long wait times were actually a symptom of a more serious problem – slow access to patient care, especially in urgent situations.
Lack of fast access to patient information was also potentially costly. For example, in hospitals served by The Newfoundland and Labrador Centre for Health Information (NLCHI), confirming proof of insurance was done manually and could take days or even weeks to pull and route paper records. In the meantime, the regional hospitals would take the financial risk of providing treatment with no guaranteed reimbursement.
Infoway and Initiate: Healthy Requirements for Client Registry
In 2006, Infoway issued a letter of understanding stating that Initiate software meets all of the strict requirements for a client registry solution as outlined in the Infoway Blueprint – a guideline for systems integration to achieve Infoway’s EHR strategy. The provinces, however, still make their own independent decisions as to whether or not to adopt Initiate’s solutions. The provinces that selected Initiate’s EMPI did so based on the superior accuracy of the Initiate algorithm as well as the speed and ease of implementing the software across disparate clinical data systems.
Initiate industry-leading EMPI instantly and accurately links data on demand to virtually integrate data across disparate systems and applications. Moreover, it can help organizations turn any volume of data into the clean, complete medical records needed to drive better, more cost-effective and responsible interactions with patients. Initiate’s economies of scale allow for central client registry standardization with regional and/or domain implementation of Initiate software.
As of autumn 2007, eight Canadian provinces have chosen Initiate software as their EMPI/client registry solution. Here is a sampling of the success some of those provinces are achieving.
Improving Data Quality in British Columbia
In 2004, British Columbia’s Ministry of Health Services aimed to improve the quality of the existing client registry and lay the foundation to enable future EHR solutions. To determine the quality of existing data, British Columbia engaged Initiate Systems. Analyzing 21 source systems, the Initiate JumpStartSM indicated that there was a high probability that many people were not recognized in the existing registry. British Columbia implemented Initiate software to support the integration of clinical data across the enterprise as well as improve management of patient identifiers and core patient-related data. In addition, British Columbia contracted Initiate partner Sierra Systems to implement a messaging layer, a set of services that helps to improve communication and collaboration by transforming messages from all disparate systems, including legacy, into a common messaging standard.
Unifying the Patient View in Alberta
Alberta’s Ministry of Health and Wellness wanted to unify the province through a client registry. Both Calgary and Edmonton had existing client registries driven by Initiate software, but they were not linked, and the remainder of the province was not covered. Initiate Systems created a solution that covers the full province and links the existing hubs together, delivering a province-wide view of each patient. This strategy enabled each territory to retain its autonomy and current structure, while laying the foundation for an EHR. Also, the Initiate solution eliminated the need for creating a third regional client registry. Alberta is also implementing Initiate's provider algorithm to support a comprehensive provider registry.
Enhancing Point-of-Service in Saskatchewan
Saskatchewan’s Ministry of Health had an existing client registry, but it was incomplete. In addition to a more robust client registry, Saskatchewan was also interested in laying the foundation for EHRs and more specifically, identifying patients at the point of service. Enhancing point-of-service performance was critical at patient registration, especially to prevent duplicate patient record creation. With the Initiate solution, patients already in the system but presenting at different facilities could be identified and have the new medical information tied directly into their existing records. In 2005, Saskatchewan engaged Initiate Systems to roll out a province-wide client registry that increased accuracy and enabled select territories to further reduce duplicate records through point-of-service integration.
Linking Eight Source Systems in Manitoba
In 2005, Manitoba Health sought to establish a client registry that would integrate with the deployment of their PACS and RIS initiatives. While Manitoba’s potential duplicate rate was very low, the client registry was viewed as an essential component, not only for the implementation of picture archiving and communications systems (PACS) and radiology information systems (RIS), but also for the creation of a foundation for a broader EHR. With Initiate software, Manitoba was able to link data from eight source systems to create a complete view of the patient across five regional health authorities. Moreover, Initiate worked closely with Manitoba Health to coordinate Initiate software deployment with the PACS and RIS systems in a tight integration to quickly achieve maximum interoperability.
Reducing Wait Times in Ontario
Ontario’s Ministry of Health and Long-Term Care wanted to create a comprehensive client registry to support its Wait Time Strategy, an initiative that was created to improve access to Ontario healthcare services and shorten wait times for diagnostic test results. On behalf of the province of Ontario, Cancer Care Ontario contracted with Initiate Systems to implement Initiate software as the client registry throughout the Province. Phase One of the project, which included six hospitals, went live on schedule at the end of March 2006. Phase Two including 50 additional hospitals went live at the end of October. Just a few months after implementing Initiate software as part of its Wait Time Strategy, Ontario’s citizens are already seeing double-digit reduction in wait times for a number of key health services. For example, as of May 2007, wait times dropped by 50 percent for cataract surgery, 33 percent for hip replacement, 60 percent for angiography, and 46 percent for angioplasty. When translated into days, the average patient is now having hip replacement surgery 116 days sooner - nearly four months - than before implementation.
Standardising Processes in Newfoundland
Integrating Patient Medical Records in Pursuit of the EMR
Newfoundland and Labrador Centre for Health Information was looking for a fast, efficient way to link, share and update patient and client demographic information across a vast geographic area serving 530,000 people in eight regions. Using Initiate EMPI software and QUOVADX™ Cloverleaf® integration technology, the province created standardized processes and created a solution for data sharing in 2005. Now, Initiate software provides the Centre, hospitals, community health offices and the provincial agencies with instant access to a single demographic record for each person. Looking to the future, the Initiate EMPI software lays the foundation for several large HIT initiatives at NLCHI in 2007, including integrating the client registry with a province-wide PACS system for imaging and a pharmacy interface.
Provincial Solutions – Nationwide Benefits
Overall, by using Initiate software as the foundation for a client registry, Initiate Systems is helping Canada to:
- Establish a nationwide patient identification solution to support the clinical objectives of the national EHR initiative
- Provide a provincial client registry deployment to create and maintain a single provincial view of the patient
- Allow for a provincial client registry to communicate and share patient identifiers across provinces
Today, the eight provinces using Initiate software are each realizing their own individual benefits. For example, Ontario integrated its client registry with the province’s Wait Time Strategy and citizens are already seeing improvements in access to healthcare services and shorter wait times for diagnostic test results. In a May 18, 2006, press release, Ontario’s Minister of Health and Long-Term Care, George Smitherman, noted an “encouraging” trend with “double-digit drops in wait times for a number of key health services.”
As a result of achieving a patient-centric view of data, The Newfoundland and Labrador Centre for Health Information (NLCHI) has overcome the challenge of manually verifying health insurance coverage. The Initiate solution provides NLCHI with a patient-centric view no matter where in the province a patient presents for treatment. Therefore, hospitals in all eight regions of the province can share insurance eligibility information at the point of registration. That is just one way the Initiate solution has improved registration processes for NLCHI.
“The Initiate EMPI gives us a province-wide source of truth for patient information that previously only existed in each region,” said Mike Barron, Project Leader, Health Information Network, Newfoundland and Labrador Centre for Health Information. “NLCHI is one step closer to achieving a province-wide EHR.”