Region-Wide Electronic Health Records for Edmonton Capital Health Region, Alberta, Canada Capital Health is one of Canada's largest integrated academic health regions, providing complete health services to 1.6 million people across central and northern Alberta, and northern and western Canada. Capital Health provides specialized services such as trauma and burn treatment, organ transplants and high-risk obstetrics. One in four patients admitted to Capital Health live outside the region. Capital Health operates 13 hospitals, with over 2,600 beds, 22 public health centers, nine mental health clinics, a nurse call centre for health information and advice, and a range of other programs.
Overview "The challenge is to effectively share patient information with caregivers across our facilities and in the community, providing secure access when and where required. With the help of Orion technology, we will be able to offer our 2,000 physicians and over 6,500 other health care staff access to an unparalleled range of patient lab results, medication information, clinical notes and demographic information." Donna Strating CIO Capital Health, Edmonton, Alberta.
Customer Profile
Capital Health Region, Alberta, Canada
Customer Website www.capitalhealth.ca
Scenario
Integration System
Business Situation Capital Health required an Electronic Health Record in order to improve the quality of care and management of resources. They initiated an RFP.
Region-Wide EHR Needed In 2001, Capital Health recognized that an electronic health record (EHR) was a strategic priority for the organization. By connecting the separate “islands” of information that existed in Capital Health’s diverse facilities and programs, a properly implemented EHR would be a key enabler to improve the quality of care, and to make better use of scarce resources.
"The challenge is to effectively share patient information with caregivers across our facilities and in the community, providing secure access when and where required. With the help of Orion technology, we will be able to offer our 2,000 physicians and over 6,500 other health care staff access to an unparalleled range of patient lab results, medication information, clinical notes and demographic information." -Donna Strating, CIO of Capital Health, Edmonton, Alberta.
Business Solution
The successful bidder was The Central Station Consortium, a partnership between five firms. Orion Health provided Concerto Medical Applications Portal. The Concerto portal integrates a number of Capital Health region’s other information systems, providing secure, region-wide access to information sources that were previously restricted to a single institution/clinic within the region.
Why a Portal?
Business Benefits •
A portal model was chosen to deliver Capital Health’s EHR for seven main reasons: • • • • • • •
A portal directly supported the objectives of Capital Health – providing a record of care that “followed” patients electronically, allowing for better care and better use of resources A portal could leverage Capital Health’s underlying information systems, achieving regional, patient-centric health information without requiring the replacement of existing patient care systems. A portal could easily leverage external systems such as Alberta’s Provincial Pharmaceutical Information Network. A portal could display health information in a consistent clinician-friendly manner across Capital Health’s facilities and programs. A portal would be easy to upgrade over time with new information sources, compared to other solutions (eg. client-server) A portal would be easy to implement within Capital Health facilities and to offer remote access to physicians from their community offices. The portal model supported advice from Capital Health’s panel of experts; namely, to deliver value to clinicians as early as possible, and utilize the existing information resources
Rapid Progress – From Vendor Selection to Full Production An RFP process was commenced in late November 2002, with four vendors responding. Two short-listed vendors were then put through a rigorous demonstration process involving Capital Health clinicians, technical staff and business staff. The successful bidder, announced in January 2003, was The Central Station Consortium, a partnership between five firms: • • • • •
Orion Health – Concerto™ Medical Applications Portal (MAP) Quovadx Inc – Aligndex Enterprise Master Patient Index (EMPI) Sierra Systems – Project Management and Integration Services Oracle Corporation – Databases Hewlett-Packard – Servers An emphasis was placed on rapidly progressing the project to offer quick wins to clinicians in the shortest possible time. Detailed planning with the vendor consortium began in March 2003, with a ‘proof of concept’ trial run in September 2003. A pilot involving ten sites and 500 clinicians was started in February 2004. Full roll-out of the production system began in April 2004 and continued through to December 2004. The rapid progress of the project was assisted by several factors:
• • • •
Strong executive buy-in for the EHR project. The CEO chaired the EHR Steering Committee. Clinician involvement at every level of the project, including a clinician design team working with portal vendor Orion Health, and a “proof of concept” or early trial of a subset of screens involving 25 clinicians Dedicated project management teams both from Capital Health and vendors Detailed project planning during contract negotiations with vendors
• • • • •
Single Accurate Source of Information Reduced Workloads and Costs Improved Clinician and Patient Satisfaction Rapid Clinician Adoption Lower Cost of Ownership Enterprise Wide Information Foundation
Technology Benefits • • • • • •
Single Accurate Source of Information Improved Clinician Satisfaction Easy to Use, Easy to Implement Lower Cost of Ownership Scalable Enterprise Wide Information Foundation Ready to Be Extended
Technology In Use Concerto Platform: • • • • • •
4 x HP rp2470 servers, loadbalanced through a network content switch 750Mhz PA-RISC Processor, 1GB RAM, 100 Mbit NIC running HP-UX 11i Number of Users: 17,000 Expected Concurrent User Load: 1700
For further information, contact: Orion Health Ltd. www.orionhealth.com International Head Office Auckland, New Zealand Phone: +64 9 638 0600 USA Headquarters Phone: +1 800 905 9151 EMEA Headquarters Phone: +44 870 432 9580
Capital Health EHR Functions Capital Health’s EHR was designed as a “read only� portal summary of patient data aggregated from systems across the region. Functions of the Portal include: Patient Lists and Patient Search Lists of current patients are provided for different user groups (e.g. current patients on a particular care unit). Patient lists are convenient for users and are also used to control access (e.g. a nurse on a unit may only have access to the current patients on that unit). Physicians can also create and maintain their own lists of patients, and search for patients across the Capital Health region.
Patient Demographics and Event History The Concerto MAP can display patient demographics as well as a 6 year history of healthcare events associated with a patient within Capital Health facilities and programs.
Viewing Transcribed Reports Patient reports available through Concerto include discharge summaries, diagnostic imaging reports, procedure notes; OR notes, consultation notes and outpatient clinic reports. Lab Result Viewing Concerto can collate and display lab results from the regional and provincial lab systems, displaying all available results from the past two years. Results can be viewed cumulatively and in graphical format to chart changes in critical values over time.
Integrating Systems across the Capital Health Region The Concerto portal integrates a number of Capital Health region’s other information systems, providing secure, region-wide access to information sources that were previously restricted to a single institution/clinic within the region. Systems integrated into the Concerto portal include: •
Quovadx Aligndex EMPI (installed as part of the Central Station Project)– for patient search and demographics, via an HL7 interface
•
Capital Health Corporate repository (Oracle 8i/9i) – for patient lists and event data
•
Capital Health Lab repository (Oracle 8i/9i) – for lab data
•
Capital Health Transcribed Reports repository (Oracle 8i/9i) – for transcribed reports
•
Provincial Pharmaceutical Information Network – for medication and allergy summaries (community-based), via an HL7 interface, encoded as XML
Protecting Patient Confidentiality The protection of patient confidentiality is a priority for Capital Health with every system. Building on its existing privacy and security policies and practices, which are based on Alberta’s Health Information Act and the Alberta Health and Wellness Security Policy, Capital Health consulted with clinician and patient representatives on the EHR. All EHR users must sign a patient confidentiality agreement prior to signing on to the EHR for the first time, reinforcing Capital Health’s privacy and security directives. Permission to access patient health information in the EHR is granted on a “need to know” basis, and further restrictions are imposed depending on the user’s role within the organization. Robust technical security is also in place. All users have a unique username and password, and all user activity within the EHR is tracked and stored in an audit log. Within Capital Health facilities, the EHR is accessed from within a firewall-protected intranet. External access to the EHR from outside the Capital Health network requires a “two factor” authentication process. Authorized users are given a small electronic key-fob, which displays a new six-digit number every 60 seconds. In order to access the Capital Health Network, users must enter this 6-digit number as well as their own PIN number.
An ongoing monitoring and auditing process is in place using reports generated from Concerto’s electronic audit logs. All users are aware that inappropriate access or use of information will result in disciplinary action, in accordance with Capital Health’s policies. Capital Health is also using the capabilities of the Concert portal to “mask” certain information – effectively putting a padlock on these records. In order to access this data, a health care provider must enter a reason on an “unmasking” screen before the data is made available. All unmasking functions are logged and audited.
Value of the EHR to Users – Testimonials Physician – “Had an elderly patient transferred from ER at another hospital, found unconscious by his neighbors… With the EHR, I was able to see the trend in his lab results over time; he had been attending the kidney clinic for some years. This history helped determine an appropriate course of care.” Physician – “ Had a young patient diagnosed with a UTI infection (or thought to have been). The next expected intervention would be surgical. EHR showed result of the previous two ‘suspected UTIs’ were not really UTIs. The intervention, which has not only a high cost but also a morbidity risk, was averted.” Resident Physician – “I was assessing someone in ER and by looking at the EHR I found out
that a CBC [cumulative blood count] had been done the day before!”
Unit Support – “The EHR is wonderful when I’m pulling and preparing charts for next day –it
saves time (approx. 10 minutes per chart) by not telephoning for lab results and is a quick confirmation of any new lab work done since the last record on the patient file.”
Future Directions Capital Health is considering multiple options for extension of its EHR system in the future. These options include possibly displaying additional patient data through the EHR, including immunization records, private radiology reports, cardiology ECGs and provincial health information. The EHR could also be linked to chronic disease management tools to assist in the management of chronic diseases such as diabetes.