ITAC Health's Alberta e-Health
Consultation Breakfast
Mark Brisson, Alberta Health and Wellness
October 20, 2009
Proposed Agenda for Presentation
• Alberta's Health System – Context
• Provincial IM/IT Integrated Planning Focus
– Example: Personal Health Portal
• Key Business and IM/IT Priorities
Alberta’s Health System - Context
Current Challenges in Alberta’s Health System
• > 35% of provincial spending and growing
• Dependence on hospital and nursing home care, yet limited
community capacity
• Close proximity and limited capacity of small hospitals
• Health provider supply and productivity
• Little coordination/integration across the health system
An Elderly Diabetic and their interactions with the Healthcare System
Diabetes Education
Centre
Public Health (flu)
4
1
5
3
2
HealthLink
Internist/
Endocrinologist
8
Pharmacy
Family Phys
6
Ophthalmologist
12
9
Diagnostic Services
Client/Patient
Legend:
1. Annual flu shot
2. Call HealthLink for advice
3. HealthLink refers to GP
4. Referral to Diabetes
Education Centre
5. Referral to specialist
6. Referral to Ophthalmologist
7. Orders for diagnostics
8. Admission to acute care
9. Discharge medications
10.Home dialysis
11.Discharge care to GP
12.In-Home Care
7
14
11
Home Care
13
10
Acute Care
Home Dialysis
Drivers of Demand and Utilization
• Population growth and aging
– Patients over the age of 65 drive 45% of annual growth.
• Average utilization of Alberta’s large acute care hospitals is
90%
• Over half of small hospitals have utilization below 75%
• Over 10% of all acute care beds are “blocked” by patients
waiting for long term care or supportive living
• Chronic disease management
Health Spending - (2009-10)
• $12.9 billion
• $3 billion for physician services
• > $8 billion to Alberta Health Services (AHS)
• > $5 billion on staff salaries & benefits
• AHS spends $29.9 million per day
• If we continue at this rate of spending, AHS’s budget will
grow by almost 200% by the year 2020
CONTROLLING COSTS WILL REQUIRE ALBERTA TO “BEND THE TREND”
Projected former RHA spending 2008-2020, baseline and optimal cases
$ billions
25,000
-6.2%
20,000
-6.3%
Projection
assuming
historical growth base
Projection
assuming
historical growth –
optimistic scenario
AHW Projections –
base scenario
15,000
AHW Projections –
optimistic scenario
10,000
08
09
10
11
12
13
14
Year
Source: AHW Economics Unit; Health & Wellness 2008-11 Business Plan;
15
16
17
18
19
20
Where have we been…
• 120 hospital boards
• 17 regional health authorities
• 9 regional health authorities & 3 boards
• 1 centralized model: Alberta Health Services
Roles of AHW and AHS
AHW
• Strategic/directional policy
• Macrosystem design
• Performance measurement
• Monitoring, compliance and
assurance
• Funding
• Capital recommendations and
approvals to Treasury Board
AHS
• Service delivery
• Operational and workforce decisions
• Operational policies
• Allocation of funds to services
• Performance management
• Capital recommendations to AHW
Provincial IM/IT Integrated Planning
Focus
Alberta “I-Plan” – 2009 - 2015
• An integrated IM/IT strategy that covers provincially-funded
healthcare IM/IT investments 2009-2015
• Links overall business plans and strategies with detailed
program/project plans
• Does set provincial strategic directions for healthcare IM/IT
• Includes specific progress/benefit measures that can be tracked to
monitor execution of the Plan
• To provide an accountability framework for monitoring progress in
executing the Plan.
• Is currently being finalized, with Health Information Executive
Committee approval expected December 2009
I-Plan Scope
• Provincially-funded IM/IT initiatives undertaken by Alberta Health and
Wellness, Alberta Health Services, Provider groups, or other
organizations in major healthcare domains:
– Point of service systems in hospitals and other healthcare delivery
institutions (continuing care systems, public health systems);
– Reference systems, provincial repositories and other components
comprising an EHR infrastructure (registries, portal, pHIE);
– Primary care and community medicine (e.g., EMRs);
– Performance management and reporting systems
I-Plan ContextVision 2020 Strategic Guidance
Integrated I-Plan
Organizational tactical & strategic plans
Personal Health
Info Strategy
PHP Project
Plans
Pub Health
IT Strategy
Pub Health
Project plans
POSP Plan
EMR Imp’n
Plans
Access/WTM
Strategy
Access/WTM
Project plans
AHS IM/IT
Strategy
AHS IM/IT
Project plans
Operational / project plans
Milestones, Metrics, benefits
EHR/NetCare
Strategy
EHR/NetCare
Project Plans
Infrastructure
Plans
Stakeholders Engaged in I-Plan
•
•
•
•
•
•
•
•
•
•
•
•
Alberta Health and Wellness Business and IM/IT Division
Alberta Health Services Clinical and IT Group
Primary Care Initiative
Physician Office System Program
Alberta Medical Association
College of Physicians and Surgeons of Alberta
Alberta College of Pharmacists
Alberta Continuing Care Association
Alberta Pharmacists’ Association
Primary Care Networks
Office of the Information and Privacy Commissioner
Canada Health Infoway
Provincial I-Plan Strategic Directions
•
•
•
•
•
Achieving universal access by providers to a complete
set of clinical data domains in the EHR
Accelerating implementation of interoperable EMRs and
other clinical management systems among independent
providers
Ensuring seamless flow of information across
continuum of care
Consolidation & standardization clinical business
procedures, and supporting IM/IT
Increasing personal access to health information
•
DOMAIN DESCRIPTION:
•
Personal Health Systems encompass all systems that grant patients access to clinical
information. These systems allow patients to play an active role in partnering to manage their
health and health care and provide them with information about themselves as well as the
system in which they receive care. Patient portals are among the most common applications
that can be used to fulfill this role and plans have already been developed to make his a reality
in Alberta over the next 5 years.
•
SCOPE STATEMENT:
•
The Personal Health Portal (PHP) is envisioned to be an innovative (web-based and telephone
service) application that will grant the public access to personalized information about
wellness, health care, health conditions and treatments, health services, as well as many other
health related aspects.
•
TARGET STATE:
•
The PHP will enable diverse health system providers to supply health content and services
through the PHP framework, and assist in making the user experience as sea mless and
coordinated as possible. Governance, standards, principles, and guidelines to support
stakeholders in defining structures and content of the PHP will also be established.
•
VALUE/BENEFITS (business language, not project-related)
•
The PHP will enable Albertans to have improved ability to proactively manage their health and
wellness, and access all health services that are available to them.
•
Patients and clinicians will have the improved ability to communicate and interact with one
another, and
•
Patients can more effectively participate in managing their treatment.
•
Patients will also be able to effectively engage the support of and assist others in their
treatment.
Example Initiative Description: Personal Health Portal
Benefits / Clinical Value
Benefits could be assessed based on potential savings
in the following six categories:
1.Diabetes savings
2.Congestive Heart Failure (CHF) savings
3.Appointment Scheduling savings
4.E Visits savings
5.Medication Renewal savings
6.Pre-encounter Questionnaire savings
Key Business/Policy and IM/IT Priorities
Business / Policy Priorities
• Legislation to enable the delivery of health services using new
models of care - MACH
• Building community capacity – Home Care, Aging in Place
• Creating a foundation of primary and public health
• Funding health providers for performance
• Implementing phase 2 of pharmaceutical strategy
• Proposing new approaches to funding health services
Key Project Focuses
AHW Primary
• Provider Claims Reimbursement
• Pharmaceutical Information
Network – e-Prescribing
• Performance Measurement / Data
Warehousing / Health System
Reporting
• Registry Integration and Development
• Health Workforce Forecasting
•
•
•
•
•
•
AHW/AHS/AMA, etc..Joint
EHR (Portal/pHIE) Deployment /
Capability Enhancements
Personal Health Portal
Identity and Access Management
Integration w/ AHS/Community
Systems
Continued Physician Automation
Public Health
• Continuing Care Technologies