ARCHIVED - RPP 2006-2007
Health Canada

Description: Canada Health Infoway is a federally-funded independent not-for-profit organization with a mandate to foster and accelerate the development and adoption of electronic health information systems with compatible standards and communications technologies on a pan-Canadian basis.

It is widely accepted that health information and communications technologies such as electronic health records (EHRs), telehealth and public health surveillance systems will significantly improve access to health care services, patient safety, quality of care and productivity. A recent study estimated that potential savings from a Canada-wide electronic health record similar to Infoway's model would be $6.1 billion annually.

Infoway collaborates with the federal, provincial and territorial governments towards a common goal of modernizing Canada's health information systems. This collaborative approach reduces overall costs by coordinating efforts, avoiding duplication, taking advantage of economies of scale, replicating successful initiatives across the country, and sharing best practices. For example, Infoway's EHR Blueprint Architecture is being adopted across Canada by jurisdictions and vendors, saving time, effort, and dollars, and helping to ensure all systems will be interoperable; as well, some jurisdictions have saved both time and money by acquiring vendor solutions together, rather than individually.

While Infoway provides advice and some funding to them, the provinces and territories are responsible for the actual system development, implementation and overall funding, including on-going operational costs.

Electronic Health Record - Infoway's goal, endorsed by all jurisdictions, is to put in place the basic elements - i.e. patient and health professional registries; drug, laboratory and diagnotic imaging systems - of an interoperable EHR for 50% of Canadians by the end of 2009. Over 140 projects are completed or underway across Canada and it is expected that an active pace will continue to be maintained in 2006/07. The following provides examples of such projects: the Registries program comprises 10 completed and 14 active projects in 10 of 13 jurisdictions; approximately 30% of physicians have now been uniquely identified, a prerequisite for EHR use; with respect to Diagnostic Imaging, there are 4 completed and 9 active projects in 7 jurisdictions; the British Columbia Fraser Health Authority plans to have all of its twelve hospitals connected to its shared diagnostic imaging system by the end of 2005/06; in Southwestern Ontario, The Thames Valley Hospital Planning and Partnership is making significant headway as seven of its eight hospitals are now able to share diagnostic images; late in the summer of 2005, the Alberta government and Infoway announced a $189 million initiative to allow hospitals and clinics throughout Alberta to electronically capture and share patient X-rays and CT and MRI scans.

Telehealth - Infoway is investing in projects to expand and sustain telehealth initiatives, particularly in rural and remote communities, including Aboriginal and official language minority communities. It is also working on linkages between telehealth and the EHR and increasing the integration of telemedicine activities into mainstream healthcare service delivery. Telehealth strategic plans have been put in place with most jurisdictions and telehealth solutions will be implemented in all jurisdictions by December 31, 2009.

Health Surveillance Systems - Infoway conducted a comprehensive needs assessment and developed an implementation strategy. Based on this, they will invest in the implementation of a pan-Canadian health surveillance system focussed on infectious diseases, in particular on case, outbreak, immunization, and alerts management, building upon surveillance systems already in place in Canada. A national steering committee, made up of experts in both information technologies and public health representing all FPT jurisdictions, has completed the solution planning work and three streams of work are underway: solution procurement and integration, to be completed end of February 2006; public health surveillance standards review and development; and jurisdiction implementation planning sessions.

Summary of Annual Plans of Recipient: In 2005/06, Infoway updated three-year joint technology and investment plans with the jurisdictions, providing a consolidated long-term 'road map' that aligns national and provincial e-health strategies. This national three-year plan will be updated annually by Infoway and the Deputy Ministers, and will serve to more tightly align the joint investments made by Infoway with the provinces and territories.

As of March 31, 2006, it is expected that Infoway will have approved approximately $650 million in project investments, with additional downstream commitments of approximately $420 million.

Planned Audit(s) and Evaluation(s): In 2005/06, independent third parties completed a financial audit, a compliance audit, and an evaluation to measure performance against outcomes set out in the Infoway Funding Agreement. In addition, Infoway prepared a Progress Report on surveillance systems.

In 2006/07, independent third party financial and compliance audits will be undertaken. Independent performance evaluations are scheduled every five years.

Infoway initiatives must generate value - measurable benefits - for the patients, providers and health care system. Therefore, Infoway's EHR solutions will be evaluated in the field to determine benefits, as well as utilization and satisfaction levels. The benefits evaluation framework is being enhanced and primary research will be stimulated in this area.

Description: The Roadmap Initiative provides the financial support for the Canadian Institute for Health Information to:

• to serve as the national mechanism to coordinate the development and maintenance of a comprehensive and integrated health information system for Canada; and,
• to provide and coordinate the provision of accurate and timely information required for the establishment of sound health policy, the effective management of the Canadian health system and generating public awareness about factors affecting good health.

Strategic outcomes: CIHI plays a major role in supporting the reporting commitments of various First Ministers Meetings and the First Ministers Accords on Health Care Reform.

The key areas identified for action under the original Health Information Roadmap were:

• Consulting with stakeholders to confirm priority health information needs;
• Developing health information standards to ensure the consistent collection, sharing and interpretation of health information;
• Filling in gaps in information on health services and related costs and outcomes;
• Filling in gaps in information on population health and factors that affect our health
• Creating a Canadian Population Health Initiative (CPHI) to provide new information and insights on health and the health system; and,
• Producing and disseminating regular, easy-to-understand public reports and conducting special studies on the health of Canadians and the health system.

Summary of Annual Plans: The 2005-06 Operational Plan and Budget was presented for approval to the Board of Directors at the June 2005 meeting, and then submitted to the Minister of Health. Some of the key projects include:

• Releasing the document Health Care in Canada 2005 and developing the 2006 edition
• Expanding the range of collaborative and analytical activities including the release of special reports on the Cost of Maternity Care (the 3rd part of the series Giving Birth in Canada), funding of health services in Canada, and the burden of neurological disorders in Canada
• Implement year 2 of the CPHI Action Plan 2004-2007 including the release of 2 sections of the 3rd part report series on Improving the health of Canadians 2005-2006.
• Further develop and implement the long-range analytical strategy/plan, including early-start projects approved by the Board in June 2004.
• Continue to develop, compile, and disseminate new and existing health indicators to address priority information needs, with a special focus on quality of care
• Complete development of CIHI's acute care inpatient grouping methodology (and related resource indicators), using ICD-10-CA and CCl activity and patient-specific cost data, and release new ICD-10-CA/CCl-based grouping methodologies for day-surgery (i.e., DPG) and ambulatory care (i.e., CACS) patients. Also, produce first-ever French versions of Day Procedure Groups (DPG) (New), Comprehensive Ambulatory Classification System (CACS) (New), and Continuing Care (RUGS-III) (New) Directories and supporting documentation.
• Continue to produce and disseminate policy-relevant analytical reports in the areas of health expenditures (National Health Expenditures Trends 2005, Preliminary Provincial/Territorial Government Health Expenditures), health human resources (e.g. workforce trends of physicians, registered nurses, registered psychiatric nurses, licensed practical nurses, provincial/territorial profile of the Evolving Role of Canada's Family Physicians (New), Geographic Distribution of Physicians in Canada (New), and health services (e.g. annual reports on mental health, continuing care, rehabilitation services, trauma, joint and organ replacements).
• Increase the scope, relevance and usefulness of our existing Health Human Resources products, including implementation (in collaboration with Statistics Canada and Health Canada) of a national survey on the nursing workforce, continued development of new data collection/reporting reporting systems for three more health professional groups (i.e., physiotherapists, occupational therapists, pharmacists) (New).
• Continue phased-in implementation of the new National Prescription Drug Utilization Information System (NPDUIS), based on claims-level data for publicly funded drug programs, and initiate expansion to include data from privately funded drug programs.
• Continue development of a Canadian Medication Incident Reporting and Prevention System (CMIRPS) designed to further enhance the safety of medication use in Canada.
• Continue to promote the adoption, and support implementation, of the National Rehabilitation Reporting System (NRS), the Continuing Care Reporting System (CCRS), the Home Care Reporting System (HCRS), and the Ontario Mental Health Reporting System (OMHRS).
• Continue to implement strategies and plans to further strengthen CIHI's presence at the provincial/territorial, regional and local levels, and identify opportunities to align existing CIHI products and services to address emerging regional needs (New).

Description: Total federal funding for the CHSRF is as follows (CHSRF's programs also receive funding from other sources):

• 1996-2001 - $66.5 M to set up the foundation and another $35 M to support its participation with the Canadian Institutes of Health Research
• 1999 - $25 M grant to support a ten-year program to develop capacity for research on nursing recruitment, retention, management, leadership and the issues emerging from health-system restructuring (Nursing Research Fund or NRF)
• 2003 - $25 M grant to enhance the skills of health system managers in the use of research to increase evidencebased decision making (Executive Training for Research Application or EXTRA) over a thirteen year period.

Strategic Outcome(s): The NRF will support research personnel, research dissemination, and research projects on nursing management, organization, and policy at a level of $2.5 million per year for 10 years. The aim is to create high quality new knowledge; increase knowledge exchange between researchers and decision makers; and increase the capacity for evidencebased decisions.

EXTRA aims to equip health service professionals and their organizations with the skills to find, assess, interpret and use research to better manage the Canadian health care system. CHSRF will continue to enrol 24 senior fellows annually in the two-year EXTRA training program designed to achieve: knowledge of research evidence; capacity to draw on system thinking; development of collaborative professional relationships; and the ability to introduce and manage evidence-based change.

CHSRF's work contributes to Health Canada's aim of strengthening the knowledge base to address health and health care priorities. CHSRF's programs further the development of health human resources, provide health managers with tools to improve primary and continuing care, and support research on nursing issues from a health system perspective.

Summary of Annual Plans of Recipient: CHSRF will continue its efforts on its four strategic objectives:

1. To create high quality new research that is useful for health service managers and policy makers (especially in the foundation's priority theme areas).
2. To increase the number and nature of applied health services and nursing researchers.
3. To get needed research into the hands of health system managers and policymakers in the right format, at the right time, through the right channels.
4. To help health system managers, policymakers and their organizations to routinely acquire, appraise, adapt and apply relevant research in their work.

CHSRF will move to consolidate and add value to its research funding activity; this will include positioning more activities in relation to its four "flagship" programs:

• Research production and dissemination:
  • i. Research Exchange and Impact for System Support (REISS)
  • ii. Capacity for Applied and Developmental Research and Evaluation (CADRE) in Health Services and Nursing
• Research use and implementation:
  • iii. Knowledge Brokering
  • iv. Executive Training for Research Application (EXTRA)

Emphasis will be placed on creative knowledge transfer and providing increased support to decision makers, as well as on organizational excellence. CHSRF's partnership work is expected to change due to the increasing number of national healthrelated knowledge agencies and the drive to identify opportunities and common objectives; and the provision of more direct assistance to grant and award applicants to help acquire matching co-sponsorship funding.