The Canadian Department of National Defence has entered Phase 2 of the war it is waging against paper-based health care. Its current mission is to build an electronic health-care record system for its members that can be accessed from anywhere
in the world.
The project, awarded to Lockheed Martin Canada, will allow more than 2,500 Canadian Forces health care employees across Canada to share information securely and provide services for 85,000 regular and reserve personnel. Along with the usual health care data related to radiology and other medical records, the system will also include dental data.
Brian Roach, project manager for the Canadian Forces health information system project, said the advantage of using an electronic system is that it will allow for a continuity of care CF members don’t have at the moment, he said.
“Right now if you’ve got a member who gets injured in Afghanistan, you’re going to have records maintained there. If that person comes back to B.C. because that’s his home base, you’re going to have records there,” said Roach.
“Cost is one driver but quality of care is probably the biggest driver for doing this, and I don’t know you can easily put a return on investment figure on that unless you’ve had to walk a mile in that soldier’s shoes.”
The first phase involved a proof of concept to make sure the vendor’s products would meet the DND’s needs. The second phase of the 10-year, $54.5-million project will cost $31 million and will involve migrating from current paper-based operations to a fully integrated system that will include scheduling and patient registration functions, clinical order review, pharmacy, laboratory and diagnostic imaging.
Phase 2, which got underway about three months ago, is expected to be completed by the end of 2006, while Phase 3, expected to begin in January 2007, will roll out clinical notes and orders and integrate management information system guidelines.
Part of the battle plan for the project includes measures to help the project stay on time and on budget, said Roach.
“We make sure requirements are understood not only at the project level but also where the strategic direction of the department is going, and where we need to make the appropriate tradeoffs we will do so,” he said.
Although it’s clear how health-care providers in Canada, even those outside the military system, will access the electronic health records, it’s not yet clear how it will work for CF staff sent outside the country on missions.
One possibility is for ships, for example, to take a laptop or mobile computing device with members’ E-HR loaded onto it that can be updated upon returning to Canada.
“We will have a deployed capability whether it’s completely within our own environment or it’s shared among the other enterprise-type systems we’ve got,” said Roach.
“You would not want to go out with three separate systems or three separate repositories, and unfortunately, most projects end up going down that path because of the way procurement happens.”
According to Roach, the DND and Lockheed Martin are working with Canada Health Infoway to make sure whatever system the DND develops is compatible with the work Canada Health Infoway is doing with the provinces on developing electronic health record standards.
The biggest challenge of the project, he said, is not so much technical as organizational.
“Business transformation is very difficult for anybody to go through but when you’re going from a completely paper-based system to a completely electronic-based system there are several iterations you have to go through,” he explained. “One is you have to make sure people are comfortable with the paper-based environment they’re in, making sure those processes are well understood, so when we translate them into the electronic environment they’re similar.”
That’s not to say there aren’t technical challenges, though, not the least of which is the fact the project spans five time zones, said Martin Munro, general manager at Lockheed Martin Canada.
“There are some challenges that relate to the public key infrastructure, and taking applications and integrating those functionalities into them because most of the health apps have not had Entrust (security products) integrated so we’ve gone through, and solved those challenges,” he said.
Although Lockheed Martin is perhaps best known for its military equipment, it has 45,000 software professionals on staff.
“This project is being rolled out over the DND wide-area network and there is a large component of security as it relates to the protection of personal information as well as the requirement for authentication and non-repudiation, so there are some security challenges related to this project,” said Munro.
To ensure the privacy of personal information, the DND will use virtual private network tunnelling over the DND WAN, as well as strictly controlled role-based security.
“People with access to the system will have access based on the role they have so you couldn’t go snooping in areas of a medical record for which you had no need,” said Munro. ”It will all be resident in secure DND facilities run over secure DND networks.”
Lockheed Martin’s partners on the project include Dinmar Consulting, Purkinje Inc., SCC Computer Consultants Inc. and Adstra.
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