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The Canadian health system has faced unprecedented strain during t= he global pandemic, which exacerbated existing systemic challenges and issu= es. Consequently, there has been accelerated urgency to alleviate underlyin= g pain points to continue to build a health system that is connected, equit= able and sustainable. Numerous issues continue to challenge our health syst= em, including inequitable access to care; insatiable demand across the syst= em, most acutely at emergency departments; the ongoing health human resourc= es crisis and the notable exodus of many health care professionals along wi= th a shortage of information technology/informatics/interoperability expert= s. It is more imperative than ever that we build a more efficient health sy= stem within the resources available to us.
There is growing recognition that timely exchange and access to co= nsistent and reliable health information can significantly improve care and= drive positive health outcomes. While there has been immense digitization = of health information over the past two decades, the pandemic further catal= yzed the adoption of virtual care solutions. We are at a critical inflectio= n point to ensure a sustainable health system, in which we must focus our e= fforts on creating the world-class interoperable system that Canadians dese= rve =E2=80=94 one which puts them in control = of how they receive care and empowers them to access and use their health r= ecord as they deem appropriate. The quintessential characteristic of an int= eroperable health system is person-centric care, in which standardized data= can follow the patient across all care settings and geographies to enable = more informed care provision, leading to better health outcomes.
As we look ahead, we must continue to modernize our health system = through the premise of, =E2=80=9CConnected Care to Enable a Healthier Canad= a,=E2=80=9D whereby all care sectors, organizations and providers are linke= d through health technology and standardized data. Digital health systems n= eed to interact with each other across all care settings so that Canadians= =E2=80=99 health information moves with them through the system, ensuring n= o patients fall through the cracks. For clinicians and care providers, tech= nology must support effective and efficient communications, and improve car= e delivery and the patient experience. Beyond accessing information for the= provision of care, health systems need to be able to access and analyze la= rge data sets to inform health system planning and performance, analytics, = research and population health management to protect and optimize a learnin= g health system for the generations to come. Similarly, health data needs t= o continue to support Canada=E2=80=99s reputation of world-class research (= e.g., biotechnology), medical breakthroughs (e.g., genomics) and innovation= .
Canada Health Infoway (Infoway) is committed to achieving a more c= onnected health system and will leverage more than two decades of progress = and experience to guide this journey. Infoway=E2=80=99s commitment means as= suming roles from convenor to standards developer to strategic investor in = order to effectively support all stakeholders across the health system in m= aking this goal a reality. To bring this goal to reality, Infoway is develo= ping a pan-Canadian interoperability roadmap that will leverage related wor= k that has been planned or already initiated within Canadian jurisdictions,= unlock value and address immediate pain points.
The Shared Pan-Canadian Interoperability Roadmap can now we downloaded from here.
Interoperability, within the context of the digital health, refers to th= e secure and timely exchange of health information between systems (e.g., h= ealth technology solutions, devices, consumer apps) and the common interpre= tation of that information devoid of additional action from users. While th= is sounds straightforward, there are many moving pieces that must fall into= place across the health technology ecosystem for interoperability to be ac= hieved. These pieces can range from consensus on the technical execution of= sending, processing and rendering information; to the development, interpr= etation and representation of the policies and frameworks that allow these = actions to take place.
Interoperability pertains to a wide array of data types, formats and use= s. While we traditionally think about interoperability in the context of an= individual=E2=80=99s care, it applies to a much broader array of use cases= , which will only continue to expand as technology advances. For instance, = as the availability of consumer-generated data (geolocation data, wearables= data, etc.) continues to grow, interoperability will be required to enable= use of the data effectively for care provisioning and secondary use (e.g.,= population health, research).
When different parts of the health system are interoperable, they =E2=80= =9Cspeak the same language.=E2=80=9D Effective information flow improves co= ntinuity of care and communication between health care providers and facili= tates patient access to their health information.
Connection, collaboration and communication have never been more importa= nt for the health system. Increased use of virtual care has highlighted the= need for secure and efficient electronic sharing of information across the= circle of care. Continuing to improve Canadian health care will require su= stained focus =E2=80=94 connected systems are healthier systems.
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Improved access and information flow from = interoperability can:
Improve access to their health information= , including their ability to manage and share it
Reduce time to diagnosis and treatment
Reduce medication errors that might lead t= o patient harm
Result in fewer emergency visits and short= er hospital stays (e.g., through more efficient and timely information and = communication)
Facilitate better transitions of care
Faster time = to market by building toward a single pan-Canadian, service-oriented Refere= nce Architecture representing building blocks that support programs and dat= a exchange(e.g., PS-CA, CA:FeX, eReferral and eConsult)
More rapid e= ntrance for new market participants through clear and defined technology re= quirements that enable compliance with variation in legislative requirement= s across the country
Time and exp= ense savings through the requirement to build to a single codebase for impl= ementation across multiple jurisdictions
Diminished frustration as vendors seek to = understand and respond to variable requirements, and the ability for more r= esource effort to be allocated to innovation, rather than base compliance= p>
Time savings= as a result of having the ability to access more complete and comprehensiv= e information in one place
Improve comm= unication with care teams across the health system
Improve conf= idence in decision-making
Increase ava= ilable time that can be spent with patients and their families (e.g., on di= rect care)
Increase sys= tem capacity and productivity (e.g., by reducing duplication of work, strea= mlining care pathways)
More effecti= ve systems planning and evaluation by leveraging data
Improve mora= le of health workers by reducing frustrations caused by inefficient workflo= ws and lack of information
Cost savings= and greater value for money
In October 2022, the first iteration of the = pan-Canadian Patient Summary Specification (PS-CA), based on the IHE Intern= ational Patient Summary (IPS) specification and the HL7 IPS Implementation = Guide, was reviewed and approved. This specification identifies the most re= levant patient health information clinicians indicated they require for the= continued provision and improvement of care, the common data standards to = ensure the data is understood at each point and the method to exchange the = data.
PS-CA will allow care solutions to contribut= e pertinent patient health information into clinical repositories, such as = provincial/regional electronic health records (EHRs), clinical data reposit= ories (CDRs), personal health record (PHRs), to improve health outcomes and= reduce administrative burden for clinicians.
Access to the pan-Canadian Patient S= ummary Specification is available here<= /strong>.
The published shared pan-Canadian Interoperability Roadmap was end= orsed by the Conference of Deputy Ministers (CDM) on March 30, 2023. = Since the endorsement, Infoway has been working with Canadian jurisdictions= to validate near-term priorities that will propel the maturation of intero= perability across Canada.
Through this collaboration, establishing pan-Canadian specificatio= ns for eReferral / eConsult has been identified as a key near-term initiati= ve. While eReferral / eConsult initiatives have been a priority in some jur= isdictions for some time, the solutions are often localized and unable to p= rovide cross-border care. Infoway will publish the pan-Canadian eReferral a= nd eConsult specifications to create a national standard, modernizing the h= ealthcare system towards connected care for all Canadians.
Infoway will do this in collaboration with the Province/Territorie= s/Indigenous groups (PTIs), as well as vendor and standards communities, vi= a Working Groups that have been established in InfoCentral with shared cont= ent that has been published in InfoScribe.
Access to the CA:eReC Wor= king Group is available here.
In January 2022, Infoway released the first draft of the Canadian FHIR E= xchange (CA:FeX) Interoperability Specification. CA:FeX Release 1 (R1) was = born out of the need to support a simple FHIR=C2=AE-based exchan= ge of an International Patient Summary-aligned document. While the first re= lease only focused on this simple document exchange pattern, Infoway=E2=80= =99s vision was always for CA:FeX to evolve into a full-fledged, system-wid= e protocol guiding the exchange of primary and complex health data structur= es.
This early version of CA:FeX focuses on a RESTful exchange of documents,= a document pattern that FHIR offers multiple choices for. It aims to provi= de clarity to implementers by identifying some of the choices currently ava= ilable, ranging from simple to a higher level of sophistication. As the spe= cification development continues, the intent is to evolve CA:FeX into a mor= e formal Integration Profile (similar to existing international profiles re= viewed throughout this paper) that provides more comprehensive guidance on = RESTful FHIR exchange patterns than what currently exists today.
Access to the pan-Canadian FHIR Exchange Specification is availa= ble here.<= /p>
The Canadian Institute for Health Information (CIHI) is developing a pan= -Canadian Health Data Content Framework (pCHDCF) to lay the foundation that= will enable interoperability across health systems. The Framework, support= ed by and aligned with jurisdictional projects, will establish the data sta= ndards, business glossary, data models (business context, information, conc= eptual and logical) and other metadata.
The pan-Canadian Core FHIR Profile Set (CA Core+) will provide FHIR prof= iles based on the business, conceptual, and logical models in the pCHDCF. T= his includes data exchange formats common across domains, as well as domain= -specific data exchange.
As the pCHDCF is still undergoing collaborative development, content in = this early draft of the CA Core+ is expected to evolve.
For more information, please refer to the = CA Core+ Interoperabi= lity Specifications.
In collaboration with the provinces and territories, Canada Health Infow= ay (Infoway) invited vendors to participate in the March 2023 Projectathon.= Projectathons are an important step and best practice approach in testing = and validation of a specification package, wherein implementers demonstrate= live interoperability of solutions (actors) in conformance with pan-Canadi= an specifications.
The March 2023 Projectathon was dedicated to supporting Patient Summary = implementation projects across Canada. The expansion of patient summary ado= ption is a key initiative within the Shared Pan-Canadian Interoperability R= oadmap; the March 2023 Projectathon convened vendors to test and collaborat= e on the specific use cases within the pan-Canadian Patient Summary Specifi= cation (PS-CA). Among other objectives, the event sought to:
The 2023 Projectathon represented a signific= ant milestone in our journey toward pan-Canadian interoperability. Read the= Infoway Projectathon March 2023 - Final Report for a summary of our 2023 event and to lea= rn more about the ongoing collaboration with our jurisdictional and vendor = stakeholders to achieve this shared vision.
Learn more about Projectathons here.