B.C. chosen as test case for disease management system

Canada Health Infoway has lined up key vendors and a provincial partner who will accelerate its $100-million plan to create a case management system for tracking communicable diseases such as SARS and the Avian flu.

IBM on Thursday said it has been selected to help design, build and support the system under a five-year contract worth $24 million. Big Blue will lead a consortium of vendors whose products are developed to handle health information surveillance. Infoway, meanwhile, has tapped British Columbia’s Ministry of Health as the official “client” to implement the system once it is complete. Infoway first announced the disease surveillance system in March of last year.

Although it is being touted as a pan-Canadian system, the project will consist of creating a single piece of software for B.C. Other provincial and territorial health authorities would then be able to purchase and set up their own copy of the software system, but using the same pricing and specifications laid out in B.C.’s contract. This will allow some consistency in terms of standards but still allow for the system to adapt to the processes and needs of other jurisdictions, said Infoway program director Tim Beasley.

“It’s a tricky way we’ve tried to stickhandle this,” Beasley said. “The one (jurisdiction) that’s least sure they’ll be able to do it this way is the government of Canada. Federal procurement people are looking at it now and haven’t gotten back to us yet.”

Infoway’s mandate is to establish a cross-Canada electronic health record (EHR) by 2009, mostly by providing funding and guidance to health-care organizations that are moving to digital processes around patient data. The surveillance system may pull data from such systems, but can also work in “standalone” fashion if a jurisdiction hasn’t set up an EHR yet. In those cases, the surveillance system data might come from client or provider registries.

IBM’s design team is creating an module with immunization histories, for example, that will keep track of a patient’s status based on information that might be accessed by a general practitioner, said Todd Kalyniuk, a partner in health care with IBM Global Business Services. Beasley said lab results might also make their way into the system.

The surveillance system will be based on Health Level 7 (HL7) Version 3.0, a messaging standard, a decision that has riled some vendors whose products are still based on the 2x version of HL7. Kalyniuk said, however, the protocols and standards are important to ensure interoperability between provider systems.

“They’ll have the ability to configure the relevant aspect of the system without losing the value of the standard,” he said.

BREAKER HEAD: Infoway goes for the iPHIS gold

Part of Infoway’s research since the disease surveillance system was announced last year was a review of the Public Health Information System (i-PHIS), which is maintained by the Public Health Agency of Canada (PHAC) and tracks a variety of health-care information in seven Canadian jurisdictions. The review showed that health authorities may have used some iPHIS modules but not all of them, and not all in the same way.

“The conclusion was there are good features in terms of look and feel, user interface and workflow, terminology used in it,” he said. “On the other hand, we didn’t see that that architecture was the basis on which we wanted to build new system.”

Infoway then produced a paper, referred to as “iPHIS Gold,” which was given to bidders on the new system to incorporate in their proposals.

“We couldn’t just take the iPHIS system and build it out, but we wanted to salvage some of the good pieces of it,” he said.

IBM will be using its WebSphere Portal software to create a user interface that will be consistent across the applications, said David Miller, executive IT architect with IBM Global Business Services. The consortium will also use the concept of a service-oriented architecture to ensure the individual copies of the system can link to one another, he said, while IBM’s Tivoli software will be used to manage performance.

“The general principle of design team is, where possible, to use off the shelf software, but it has to be knitted or glued together,” he said.

The system will also include software from Tuscon, Ariz.-based Scientific Technologies Corp, which Beasley described as a market leader in immunization management products, among other vendors.

“We knew we would have to do some new development work on top of some existing products,” he said.

Beasley said the system will have to work in compliance with the various health privacy laws that exist across Canada. Its choice of B.C. as a partner may raise the ire of privacy advocates, given the B.C. Ministry of Health’s decision to outsource the management of medical records to a U.S. firm two years ago. Spokespeople from the B.C. Ministry of Health did not return phone calls at press time.

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