During the planning and development of an electronic health record (EHR) what you are talking about and doing is fundamentally putting information out there for others to, at some point in time, pull from.
At least, that's the perspective of Linda Miller, assistant deputy minister and CIO of Alberta Health and Wellness.
Miller's baby, Alberta Netcare, is the single name for all projects and activities related to Alberta's EHR and its health care portal.
Alberta Health and Wellness is set to create an integrated EHR, says Miller that will eventually be accessible to every health care provider in Alberta. And by creating one integrated, province-wide system, Alberta Netcare will have linked clinics, hospitals, pharmacies and other points of care to patient information.
"It's already rolled out to all rural areas, and all health regions have access to it province-wide," says Miller. "There are more than 2,500 (of 6,000 points of care) that have access and one-third of all pharmacies have it at their fingertips."
Alberta has nine regional health authorities that provide services beyond the basic provisions of the Canada Health Act and are responsible for hospitals, continuing care facilities, community health services and public health programs.
The goal is to have all lab data online by this spring and all drugs dispensed through its network by the end of summer. Alberta aims to also have all diagnostic images and text reports accessible through the system by next spring, Miller adds.
There are currently more than 17,000 health care professionals registered to use the Alberta Netcare portal, according to Netcare's Web site. Miller and her colleagues have come a great distance and from humble beginnings.
"In the mid-90s there was a very broad-based analysis done of the current IT infrastructure in the health care system, and a kind of current 'state of the province' report was created," she says.
The report was completed with the regional health authorities, which at that time were very new, adds Miller. "Many gaps were found and concerns around older technologies grew."
In many cases, whole health care systems did not talk to each other, she says, because they either did not speak the same language or others simply weren't capable of sharing information.
The real challenge was identifying what would need to occur to enable a routine exchange of health care information, says Miller. It was recognized that sharing information would improve the sustainability and effectiveness of the health system if the information could be exchanged at point of care.
Professionals tend to share information on a point-to-point basis, Miller explains. "This means that if I know a doctor because I trained with them, and I know they are a good physician, I'll refer all my patients to them because of that. That one-to-one type of relationship is a very close part of the health system."
At the time, this generated the development of a body called Alberta WellNet. WellNet was a central I&IT set of services, says Miller, to help develop provincial systems or provincial strategy around identifying priorities and how health care experts implemented more IT.
"How do we engage the various stakeholders that are in the health care system and how do we get them to agree on a common plan?"
A registered nurse, Miller has been well served by having both a clinical and an I&IT background.
"Most of my career has been in the service delivery aspect of the health system, both clinical and in administration," she says. "It gives me a good appreciation of how the system works or perhaps does not work. I've always had an interest in information systems and the capabilities that they can provide clinicians."
Miller says she certainly understands some of the root challenges that providers face in terms of not having automated tools and not having information at their fingertips. It helps guide her and lets her understand the business needs.
"That, coupled with a reasonable sense of I&IT, has proved a great combination for me."
It goes without saying that a health system is vast in scope. Miller points to the many different kinds of stakeholders and service delivery agents.
"Getting all of those stakeholders to work together for this purpose, in whatever way necessary, was very challenging," she says. "All of them had very important local needs as well, so you can't rush this thing."
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