Tuesday, February 24, 2015

It Is Interesting To See What Is Happening With A State Wide EHR in Alberta. Talk About A Slow Burn.

This web site was pointed out to me last week:
Here is the description from the home page:

Welcome to Alberta Netcare

Alberta Netcare is the name for all the projects related to the provincial Electronic Health Record (EHR) — a secure and confidential electronic system of Alberta patients' health information.
This website has resources for the Alberta public, Alberta health care providers, and people outside of Alberta who are interested in learning more about this innovative initiative. Please read the section below "How to Use this Website" to find information that will be most relevant to you.”
The web site is interestingly dated 1995-2015. So this has been underway for 20 years or so.
Before going further some basics.
Alberta is a province of Canada with a population of a little over 4 million.
Here is some background to the Health System from Wikipedia:

“Health care

Alberta provides a publicly funded health care system, Alberta Health Services, for all its residents as set out by the provisions of the Canada Health Act of 1984. Alberta became Canada's second province (after Saskatchewan) to adopt a Tommy Douglas–style program in 1950, a precursor to the modern medicare system. Alberta's research institutions and hospitals give AHS the title of third-best-run hospital centres in the world for Edmonton and Calgary, and fourth-best research institution, referring to the University of Alberta's health campus.[92]
Alberta's health-care budget was $171.9 billion during the 2013–2014 fiscal year (approximately 45% of all government spending), making it the best funded health care system per-capita in Canada. [93] Every hour more than $1.9 million was spent on health care in the province in 2013. In 2014 this went up to $2.4 million an hour, totalling $210 billion when both private donations and government spending are accounted for.[94] Per person in Alberta, $51,220 was spent on in the health-care sector.”
This figure is to be compared with Australia where the total expenditure (Govt. and Private) according to the AIHW is $A147 Billion per annum for about 24 million people- so they are big spenders!
For the EHR we have this description:

Alberta Netcare: Created in Alberta for Alberta Health Professionals

How does the EHR work?

The EHR is not a single database, but rather a network of data repositories and information systems. Each has an important function and together they form the provincial EHR.
Clinical data is collected through point-of-service systems (in hospitals, laboratories, testing facilities, pharmacies, and clinics), and is sent through secure messaging to the provincial repositories and information systems. When a health professional logs on to the EHR through the Alberta Netcare Portal, and searches for a patient record, the portal retrieves all of the available information from the provincial systems and presents it as a unified patient record.”
The current status page is very interesting.

Current Status: When Will Alberta Netcare be Complete?

Drug Domain: near complete

Approximately 95% of the expected drug dispenses from community pharmacies are successfully entered into the EHR. 96% of Alberta's community pharamacies are actively submitting their dispense data. 
Currently health professionals view medication profiles through the Alberta Netcare Portal viewer. Two projects are underway to deliver medication information directly to local systems, which will eliminate the need for health professionals to open the Alberta Netcare Portal to view the information. Read more about System to System for EMR and System to System for Pharmacy.
The next major development for this domain will be to introduce electronic prescribing or e-Prescribe, which will see community physicians entering a prescription into the EHR, and pharmacies dispensing against that prescription. This e-prescribe function will be piloted in late 2013.

Laboratory Domain: near complete

Approximately 99% of all public and private laboratory facilities are submitting information to the EHR. Currently, Alberta Netcare is working on a Laboratory Information System Standards and Terminology Adoption project, which will standardize the transmission of data to the EHR, and will improve the quality and reliability of laboratory data.

Diagnostic Imaging Domain: near complete

The Diagnostic Imaging project (involving X-rays, ultrasounds) achieved a 100% filmless environment for all hospitals in Alberta in 2009. These images were made available province-wide through the implementation of a Provincial Image Viewer in June 2011. In 2013d Alberta Health Services completed the selection and implementation of a provincial voice recognition system and a provincial diagnostic imaging 3D reconstruction application. Approximately 92% of diagnostic imaging facilities are providing information to the provincial EHR. Read more about Diagnostic Images in the EHR.

http://www.albertanetcare.ca/images/Switch-Arrow-close.gifShared Health Record: underway

The Shared Health Record will introduce additional information to the EHR, such as patient encounters and immunization records from community sites. The Shared Health Record will also allow two-way communication between physician offices and the EHR, enabling clinicians to download EHR information to update their local systems. Read more about the Shared Health Record.

Physician Office Automation: underway

Automation of primary care physician offices is a key component of a complete provincial EHR. Currently, 77% of eligible physicians are being funded to adopt Electronic Medical Record systems, which will allow them to fully participate in the EHR.

Personal Health Portal: underway

In May 2011, a website was launched to provide a source of trusted health information and health management tools. As it evolves, a personal health record function will be introduced, allowing Albertans to create their own secure online health records. These personal health records will be enhanced to receive information from the provincial EHR. Read more about MyHealth.Alberta.ca.
The EHR is a dynamic network of systems, each designed to collect and contribute information from the various health system domains. The EHR is constantly evolving in response to the changing needs of the health system, and drawing upon new technologies as they emerge.
Since the EHR is made up of a number of systems, the status or the "level of completeness" of the EHR is expressed in relation to each domain. Alberta Netcare has made excellent progress in the drug, laboratory and diagnostic imaging domains, with content and functionality near completion. The EHR will continue to implement enhancements to improve patient care, however, it is expected that the majority of required functionality will be complete by 2020.
----- End Extract.
Further browsing revealed that only clinicians can access the portal based record - and can’t access their own record - and if the individual want to know what the record contains they can request a printout!
Also all records are derived automatically from the various services in Alberta picking up data from pharmacies, labs and radiologists.
This system looks to be the absolute opposite of the PCEHR - with no personal control or electronic access to the EHR that the doctor can access!
Well worth a browse around the whole site. Does anyone know of any published evaluations of clinical effectiveness?

No comments: