Infoway boss paves way for national e-patient record

His deadline is almost five years away, but don’t expect Richard Alvarez to slow down anytime soon.

Appointed earlier this year to lead Canada Health Infoway, the federal government corporation with a goal of accelerating the

development of interoperable electronic health information systems, Alvarez has been spending the first months of his tenure reaching out to the public and educating them about the organization’s mission. His big project? Keeping a promise that all Canadians will be able to access their patient record electronically by the end of the decade.

Alvarez spoke with on Thursday to discuss the challenges he faces and his sense of how patient records projects are shaping up. What are the most important strengths you developed in your previous roles that you’ve brought to Infoway?

Richard Alarez: My background basically is that of an information technologist. That’s where I come from. I also come initially from the private sector, but over the last 20, 25 years, I’ve been very much involved in the health-care sector from a policy perspective and from an information perspective. I’ve been looking at the industry in some cases from an IT perspective, and in my most recent job — as president and CEO of Canadian Institute for Health Information — looking at how we measure the effectiveness of the health-care system in Canada. I bring the skills in terms of the industry, which is health care. I bring a background in information technology, which I’ve always believed is a major catalyst for change. I also spent about 12-15 years working in the provinces before I worked at a national level, so I bring both perspectives, if you like. In health care in Canada, it is partly a federal responsibility for setting standards, and for delivering and managing the system it’s a provincial responsibility. So being able to understand where the provinces are coming from, where the federal government is coming from and being able to bridge that gap and broker partnerships is exceedingly important.

ITB: You deal with so many standards issues — data standards, messaging standards. How do you set priorities?

RA: When I came to Infoway I looked at this enormous mandate, which is very complex and very, very ambitious. One wonders how to start, and quite frankly it’s like eating an elephant: you’ve really got to do it a bit a time. I said to myself, ‘Look, we want to get to a pan-Canadian electronic health record. Well, you know what? That’s not going to happen overnight, and incidentally, before we get there, wouldn’t it be nice if hospitals or physicians could access data from laboratories across the street, never mind across the country? We have to get to, if you like, a pan-community, with interoperability. Build on that and you’ll get to pan-provincial interoperability, then build on that and you’ll get to pan-Canadian interoperability.

The good news here is the standards are the same standards. There may be slight variations in terms of their interpretation, but the data standards, the messaging standards are the same standard. You’re basically sending a burst of information which is pure and protected, which basically has some of your demographic information. It identifies who the test was done on, what the test was, what the diagnosis is. Those are basically standard across the country.

ITB: What’s the hardest part of your mandate?

RA: There is a lot of bits of information, right? So what is it a physician needs to see in any point in time? The answer to that depends on who the physician is. Is he a specialist? Is it a general practitioner? Is it an emergency physician? The bits of information they need to see vary from their settings and from their roles, and from the patients they see. The challenge is developing that data set with sub data-sets for the various providers of care. And the big challenge I’m finding here is we’re looking at a major transformation in this industry. I’m calling it — and my communications people will probably hate me for doing this — but it’s disruptive technology. But I call it that because it’s going to change the way people practice and people work. Today they’re working with pieces of paper, and they’re working very much in a batch mode. We’re trying to move it into a real-time, online mode, working in some cases onscreen. You’ve got to understand these bits of paper they have, how they bring them together, and how we can transfer that so they can look at it on the screen and the data is all there, so they’re not clicking five, 10 or 20 times. Physicians won’t do that.

ITB: Electronic patient records are bringing IT managers in closer collaboration with health-care providers than ever before. How do you make sure the relationship is positive and constructive?

RA: Well, you’ve got to have a broker. And the broker has got to be a clinician. What we’re trying to do is to find and farm out some of these physician leaders who have a real interest in information technology. I’m doing that. In fact, one of the first things I’ve done is to hire a family doctor to work at Infoway. She’s had her office automated with the local hospital that she’s been getting her lab tests and drugs from, which has an electronic health record, for the last five years. She understands as a physician the value. She’s not a technologist. She understands for her to practice and provide best practice, what kind of information she needs and the form she needs it in. So what we’re trying to do is get her out there to find other physicians like her, and also to try to articulate the value automation to other physicians. What we then need to do is have — and in some cases it’s working very well — is have physicians involved in the IT projects, working with the IT teams, translating to the technicians what their needs are. If you just talk technician, spending five minutes to a half an hour with a physician and then trying to build a system, it’s just not going to work.

ITB: Once we reach that pan-Canadian system, what do you think we’ll need to do to train physicians so they’re ready to take on this role of not just health-care provider, but manager of information?

RA: You’ve just hit the nail on the head. We’re talking a change in role here. We’re talking physicians having a lot of information available to them, not only on the patient but on the disease. Change management and training is going to be absolutely key. It’s going to be less important, I suspect, with some of the younger guys who are in med school today, and who are quite happy using a BlackBerry and a wireless piece of technology. Unfortunately the bulk of our physicians are in this bubble, having left school 20, 30 years ago, and have been working in this batch mode. We need to spend a lot of time educating them. In fact, 35 per cent of our projects and investments are for working with clinicians and basically putting them through a variety of training and getting them to adopt the new systems. It’s a non-trivial exercise: how do you teach them new tricks?

ITB: Some hospitals already have sophisticated electronic patient records, like Edmonton’s, but others have barely got started. How do you establish the baseline of what every provider should offer?

RA: You’ve got to have some sort of goal, like if you want to put a man on the moon. Our goal is by 2009, we want 50 per cent of Canadians to have access to an electronic health record, which means they go see their provider and that individual would be able to pull up their electronic health record. It also means being able to define what an electronic health record is: your general information, your drug history, the lab tests that you’ve received, the reports on your diagnostic imaging, the physician’s notes, the referral notes, and a couple of other things. That would be what we call a minimum data set for interoperability health records. When I first came in and started to understand the task that we had, for some unknown reason I was faced with communities of people who actually thought we would hit this switch somewhere, and all of a sudden there’ll be this pan-Canadian electronic health record. Well, it’s not going to work that way. It’s going to be organic, and what we’re going to see is what you’re seeing today. It’ll be the Edmontons and the Ottawas, and soon Calgary and Vancouver. They’re starting to develop the availability of these electronic health records. In some cases they will start at the hospital, and then move out from the hospital to the community. In the meantime there is work going on in those community settings that will bridge back to the hospital and to some of the provincial systems. That’s why it’s really important we have a map, a blueprint and an architectural design of how all these things are going to fit together from a standards point of view. And we’re using that rigorously.

Comment: [email protected]

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