Health Informatics in Canada
The Canada Health Act (1984), is the federal legislation that defines the underlying principles of the Canadian healthcare system with criteria mandating universality, public administration, comprehensiveness, accessibility and portability 1. The Canadian healthcare system is publically funded and privately delivered 2. The responsibilities of the Canadian federal and provincial governments for various aspects of healthcare are specifically defined. Provincial and territorial governments are responsible for the administration and delivery of most health related services in Canada, and each administers a specific health insurance plan to meet their mandate, as defined in the Canada Health Act 1.
Health Informatics in Canada
Health informatics are playing an increasingly significant role in the delivery of Canadian healthcare. There are a variety of public and private entities that play significant roles in contributing to the development and support of Health Informatics in Canada.
Canada Health Infoway is a federally funded, independent, not-for-profit, provincially supported organization with a purpose “to realize the vision of healthier Canadians through innovative digital solutions” 3. Infoway is accountable to its’ Board of Directors which includes federal appointees, provincial/territorial appointees and 4-6 independent directors, as well as to its' Corporation Members (Deputy Ministers of Health of the federal and provincial/territorial governments) 4.
Three major goals have been set by Canada Health Infoway for 2016-2017 5:
• “facilitate better, safer and more appropriate prescription drug use by Canadians by establishing a multi-jurisdiction e-prescribing solution”
• “scale proven, patient-centred digital health solutions to empower patients and deliver access, quality and efficiency benefits”
• “continue to leverage foundational investments to support more seamless health services and provide better informed care”
Infoway supports a variety of informatics programs and provides a number of health informatics services. Infoway provides oversight for certification of health information vendor solutions (Vendor Certification Services), facilitates "Clinician Peer Networks" , and supports the development of standards and processes for interoperability of health information systems (Clinical Interoperability and InfoCentral ).
The Canadian Institute for Health Information (CIHI) is an independent not-for-profit organization that “provides essential information on Canada’s health system and the health of Canadians” through creation and support of a variety of data standards, metrics, databases, and analysis and reports. CIHI maintains the National Ambulatory Care Reporting System (NACRS) database for ambulatory care, (including emergency departments) and acute inpatient care databases.
COACH, Canada’s health informatics association represents a diverse spectrum of professionals involved in the field of Health Informatics 6. COACH is actively involved in the development of national and international standards for health information, and has been actively involved in initiatives related to patient safety and health information systems. COACH supports many professional development initiatives in the field of Health Informatics and has collaborated with the Healthcare Information and Management System Society (HIMSS) in the creation and maintenance of the Certified Professional Healthcare Information and Management Systems – Canada (CPHIMS-CA) credential.
The private sector has made a considerable contribution to health informatics in Canada, including participation by vendors, system integrators and consultants, who are actively involved in the development of health information systems and their related processes.
Provincial Health Informatics Initiatives
The provincial electronic health record in Alberta is called Alberta Netcare. The current Alberta Netcare EHR is the result of an evolutionary process involving a variety of health informatics initiatives, dating back to 1999 7. Alberta Netcare incorporates data related to the vast majority of medications dispensed in the province, as well as the results of laboratory testing and diagnostic imaging done in the province 8. Alberta Netcare information is confidential and protected by a variety of levels of security, and accessibility is limited to authorized individuals. The Alberta Health Information Act (HIA) provides a legislative framework related to access, collection, and utilization of health related data in the province 9.
Canadian Discipline Specific Health Informatics Initiatives
The Canadian Emergency Department Information Systems (CEDIS) National Working Group is a collaboration between the Canadian Association of Emergency Physicians, L'association des médecins d'urgence du Québec, the National Emergency Nurses Affiliation, Canadian Paediatric Society and the Society of Rural Physicians of Canada. The CEDIS National Working Group has developed standardized national data elements related to delivery of emergency care in Canada 10. In collaboration with CIHI, the CEDIS National Working Group has developed a list of standardized emergency department presenting complaints (PCL) 11, and a CEDIS Diagnosis Shortlist (CED-DxS) 12 consisting of ICD 10-CA diagnosis relevant to emergency department care. The collaboration of the CEDIS National Working Group and CIHI supports these lists, and has facilitated common data definitions between the CIHI National Ambulatory Care Reporting System (NACRS) emergency department dataset and the CEDIS dataset.
1. Canada's Health Care System [Health Canada, 2011] http://www.hc-sc.gc.ca/hcs-sss/pubs/system-regime/2011-hcs-sss/index-eng.php Accessed October 20, 2016.
2. Library of Parliament - Private Health Care Funding and Delivery Under the Canada Health Act (PRB 05-52E) http://www.lop.parl.gc.ca/content/lop/researchpublications/prb0552-e.htm Accessed October 20, 2016.
3. About Us - Canada Health Infoway https://www.infoway-inforoute.ca/en/about-us Accessed October 20, 2016.
4. Board of Directors - Canada Health Infoway https://www.infoway-inforoute.ca/en/about-us/about-canada-health-infoway/board-of-directors Accessed October 20, 2016.
5. Summary Corporate Plan 2016-2017 - Canada Health Infoway https://www.infoway-inforoute.ca/en/component/edocman/resources/i-infoway-i-corporate/business-plans/2858-summary-corporate-plan-2016-2017?Itemid=101 Accessed October 20, 2016.
6. About Us - COACH: Canada's Health Informatics Association http://coachorgnew.com/membership/About-Us Accessed October 21, 2016.
7. The History of the EHR - Alberta Netcare http://www.albertanetcare.ca/History.htm Accessed October 20, 2016.
8. EHR Usage Statistics - Alberta Netcare http://www.albertanetcare.ca/Statistics.htm Accessed October 20, 2016.
9. Office of the Information and Privacy Commissioner of Alberta https://www.oipc.ab.ca/legislation/hia.aspx Accessed October 20, 2016.
10. A Consensus-based process to define standard national data elements for a Canadian emergency department information system. G. Innes, M. Murray, E. Grafstein, for the Canadian Emergency Department Information System (CEDIS) working group. CJEM 2001;4:277-284. https://www.cambridge.org/core/journals/canadian-journal-of-emergency-medicine/article/a-consensus-based-process-to-define-standard-national-data-elements-for-a-canadian-emergency-department-information-system/2FC077684342641015184C2E77A2D310
11. Grafstein E, Bullard MJ, Warren D, Unger B; CTAS National Working Group. Revision of the Canadian Emergency Department Information System (CEDIS) Presenting Complaint List version 1.1. CJEM. 2008;10:151-73. http://caep.ca/sites/caep.ca/files/caep/files/cedis2008.pdf
12. CED-DxS The Canadian Emergency Department Diagnosis Shortlist http://caep.ca/sites/caep.ca/files/caep/ced-dxs_tcdmu_2015_v_4_0_0.pdf
Submitted by Brian R. Holroyd, MD, MBA