The pan-Canadian agency responsible for creating a national electronic health record has added to its workload by promising to develop a $100-million case management system that will track communicable diseases such as SARS.
Canada Health Infoway (CHI)
(CHI)on Thursday said it is hoping to have specifications for the proposed solution, which would consist of modules that would be implemented differently across the country, by April 30. A technical team will spend next year building and integrating the system, while another team will map out how the implementation would happen from province to province. The earliest version of the system would likely be available within about two years.
Tim Beasley, CHI program director, said a concept architecture was developed last year that described what various pieces of a public health surveillance system would look like. “We’re now putting flesh on those bones in deciding which of those pieces need to be built and which can be bought,” he said.
There may be some systems already developed within the Canadian health-care sector that can provide some of what the surveillance system would offer, Beasley said. An early stage of the project will include a review of the integrated Public Health Information System (i-PHIS), which is maintained by the Public Health Agency of Canada (PHAC). Spokespeople for PHAC were unavailable at press time.
Ontario is also working on its own case management system for managing disease outbreaks, and this may be incorporated into the national system, Beasley said. The Ontario system, however, is primarily concerned with early detection.
“It’s putting a number of cases together, identifying what those cases have in common to see if there’s a common source,” he said. “But there’s also a whole raft of information management around what you do to contain the outbreak that could involve quarantine action, isolation, moving vaccine to a certain locality.”
PHAC and other agencies are already subscribers to a Global Public Health Intelligence Network (GPHIN), which gathers and disseminates preliminary reports of public health significance on a real-time, 24/7 basis in seven languages. GPHIN, however, gets its data from the media and other sources, while the CHI-proposed project would mine information directly from patient records.
Although some Canadian provinces, including Alberta, have made significant headway in developing an electronic health record (EHR), Beasley acknowledged that synchronization between the proposed public health surveillance system and EHRs is a long-term prospect.
“What will happen is that this communicable disease information will unfortunately have to be fed mostly by the long-suffering staff at public health agencies that have to key enter a lot of the data,” he said. “In the near term, our job is to design and build surveillance systems so that they’ll have the hooks built into them to be able to accept input from EHR, but realizing that EHR systems are not going to be universal.”
Infoway’s target is to have EHRs covering half of Canada by 2009.
CHI will be spending approximately $30 million to develop the public health surveillance system, with the other $70 million going towards helping various jurisdictions implement it.
The United States Center for Disease Control has been trying for some time to develop its own National Electronic Disease Surveillance System (NEDSS), but few states have implemented it, Beasley said.
“I think it’s gone slower than they originally hoped,” he said. “They’ve produced some pretty good software, but a little too oriented towards state-to- federal reporting, and not as much about the states doing their own case management work.”
CHI’s biggest challenges include making sure the final system adheres to various health-care data standards, as well as comply with the differing privacy legislation that may affect the information of a disease patient.
There is already an obligation for provinces and territories to report communicable disease information, Beasley added, but each jurisdiction will also have to conduct a privacy impact analysis of how the proposed system would affect their area. These will be submitted to CHI for review.