MEDITECH continues to remain at the forefront of the effort to facilitate interoperable health care, building on our history of working with customers to establish integrated delivery networks and RHIOs. Our dedication to this movement also spans beyond U.S. borders, and is most evident in our partnership with Canada's many hospitals. The pan-Canadian initiative is now well underway, as the country works toward their interoperable goals through the creation of provincial interoperable Electronic Health Records (iEHRs).

Expanding the Health Information Exchange View throughout Canada
According to Ron Parker, Group Director EHRS Architecture at Canada Health Infoway, his organization has a unique strategic investor role which brings together a collaborative engagement model, a shared governance model, and a gated funding approach to accelerate the implementation and adoption of EHR solutions across Canada. In his current role, Parker was the lead architect for the second version of the EHRS Blueprint set forth by Canada Health Infoway (CHI). "We do not refer to our health care architectural model as a federal model, since that applies a top-down government-imposed approach," he says. "Rather, we prefer to use the term pan-Canadian, as it represents the collaborative approach used across Canada."

With 245 active and completed projects spanning the country, Parker feels there is still much more to be done. "Even with Newfoundland and Labrador moving ahead of many other provinces, we've really just begun. It will be about 2010 before we see the first EHRs completely interoperable and developed," he says.

Keeping the Patient at the Centre of the Circle of Care
The ultimate goal for Canada is to be able to share all health care information across the country, with all health care facilities, resulting in a transparent system for all caregivers. Parker believes MEDITECH's EHR will eventually help get them there. "There are various forms of EMRs, but unlike other forms of electronic records, the EHR provides information beyond what is available locally," he says. "It shows the current state of a person's health, as well as a history of their encounters with the health care system, across multiple care settings and disciplines."

Every health care organization throughout Canada has its own I.T. model, but all must adhere to Canada's national standards. This is a requirement for funding before information can be stored in the shared space, known as the Shared EHR. This common method of data storage is accepted and in use by jurisdictions with updated architecture to include privacy and security requirements. In the Canadian EHR model, MEDITECH applications would contribute to the shared EHR repository in each province and will display, along with information native to the MEDITECH system, information from the shared EHR. The requesting source won't keep or store this data in the local application repository.

However, sharing information is the biggest obstacle in every health system worldwide, and Canada is no exception. "Canada is still working on a number of privacy issues that result from sharing data," says Parker.

"It is important to state that not all information captured by local information systems will be placed in the Shared EHR. The information being shared should be clinically relevant to support decision-making by clinicians and other health service providers. Fortunately, Canada has developed an EHR Solutions architecture expressly designed for this purpose. Unlike the U.S. document-sharing system, once connected to an EHR infostructure, the connection is 'always on'."

Future Vision for Canada's Infostructure
In 2006, Canada updated its health infostructure plan spanning the next 10 years, with a focus on supporting timely access to quality care. Five priorities were identified, including:

• Finish what is already started in electronic health records and public health surveillance

• Implement electronic medical records in physicians' offices and physician order entry systems in hospitals

• Deploy wait time management solutions

• Implement consumer health solutions to support self-care

• Integrate chronic disease management solutions, starting with diabetes.

"Such an undertaking requires both clinical and administrative transformation, with steps laid out in an incremental fashion," says Parker. "Ultimately, our goal is to end up with a chained (federated) network of these shared EHR repositories, which shares information seamlessly. We want to see the broadest possible information about patients over their entire care history."

The Newfoundland and Labrador EHR - the Client Registry Project
Another Canadian organization MEDITECH has been working closely with to achieve their EHR goals is the Newfoundland and Labrador Centre for Health Information (NLCHI). Newfoundland and Labrador not only has the distinction of being the most easterly province in Canada, but it also is one of the most unique land masses in the nation, with multiple regional integrated health authorities.

"We are a large province with an appropriately large network but with a small population," states Mike Barron, CEO. "We began the journey of providing electronic patient information to health care providers in the 1980s by implementing the MEDITECH system in various health regions."

With nine discrete implementations of MEDITECH (8 MAGIC and 1 Client/Server), along with a provincial community health system and health insurance system, a sturdy framework was in place for creating the EHR environment. "Because we are a large network of health authorities, it was imperative to identify the client accurately throughout the MEDITECH environment," Barron says. "Implementing the Client Registry became the building block for the electronic health record and province-wide client identification."

Newfoundland's Client Registry connects the registration points of all regional health authorities, while enabling cross-referencing of medical record numbers, and facilitating the consolidation of health information from multiple sources. "Ours was the first province-wide client registry implemented in the country," Barron says. "The Client Registry accomplishes the first step in the EHR, as it creates the same source of truth, providing accurate patient identification to ensure the right health records are available for the right patient at the right time."

Ready for Success at the Next Level
The key to transformation goes beyond I.T. solutions; for Canada's health care organizations, as well as for hospitals worldwide, it's also about process change. "You need to understand the way people do their jobs," stated Barron. "Think about where the process begins. It starts with registration staff, which may have the most important job when it comes to getting data into your system. You also need to have collaboration and meaningful engagement, not only with your stakeholders, but also with your end users, to ensure they understand the importance of the process."

Fortunately, MEDITECH and the NLCHI staff have been able to collaborate on projects as a virtual team, even with many miles separating them. "We weren't in the same room, but we were on conference calls, all working from the same specs," says Barron. "We plan to be working together quite a bit, going forward. We're in the process of establishing a Provider Registry, a Pharmacy Network, Diagnostic Imaging/PACS, a Laboratory domain, and an iEHR."

The next steps for NLCHI involve identifying, procuring, and implementing the technology infostructure required for the iEHR, and aligning this technology with Infoway's infostructure and standards direction. The DI/PACS, Pharmacy, and Primary Health Care projects are expected to help drive these activities.

"We would like to see all systems interoperating within the next 5-10 years," says Barron. "MEDITECH is a big player in the big picture, and with their help, we hope to secure the biggest item on our wish list: improvement in the health of our patient population."