Update #2 – Looking to the great white north

Jan. 2, 2015

In June, I spoke with Dr. Chris Jaeger, Chief Medical Information Officer and Vice President of Medical Informatics at Sutter Health, about his work with Orion Health in the area of population health management. In short, I left the interview very intrigued by his repeated reference to Orion Health’s global reach and experience. In particular, I found it interesting when he stated that his team’s visit to Alberta Health was “tremendously important” in terms of Sutter Health learning practical and proven methods of effectively managing a wide health population.

I wanted to learn more about Orion Health’s work in Canada, so for the second update of this Living Case Study series, I contacted Gary Folker, Senior Vice President, Orion Health Canada. His work at Alberta Health relative to population health serves as the industry’s gold standard. As you read the transcript of his interview, take note of Folker’s references to “seeking and sharing blueprints” and “always looking for the next process.” These motifs run deep within Orion Health’s partnerships, and they drive the company’s efforts to raise the standards of effective population health management processes.  

HMT: Please describe your role within Orion Health as well as your experience in the healthcare industry.

Gary Folker: My position is Senior Vice President for Canada, and I have the responsibility for Orion Health throughout the country. I have been involved in the healthcare market in excess of 35 years. I have witnessed the evolution of health information and population health. I go back to a point where all health information was on paper. I have seen the changes in the way we handle health information and the key advantages of having health information in electronic formats. Most importantly, I have learned how these records can serve as the engine of effective population health projects.

My career has been about seeking and sharing blueprints for success – success not only in terms of an organization’s financial returns, but success in terms of an organization’s increased patient care and satisfaction. I have found this approach to be vital in the area of population health.

HMT: For the sake of establishing a bit of context, what are the key forces within Canada’s healthcare system?

Folker: In Canada, we are organized.

The Canadian healthcare business revolves around 10 provinces and a couple of territories in the northern part of Canada. Healthcare is delivered through provincial mandates. As you are probably aware, our healthcare is paid for through a taxation system. The taxes are collected by the federal government and then transferred to the provincial governments. The provincial governments have the responsibility within that dollar allocation to deliver healthcare to the citizens of their province. That is important to understand, because then each province can set its own direction; its own tone. They can determine what their priorities are and where they are going to spend their healthcare money. We are dealing with 13 provinces, for all intents and purposes. Each one is somewhat autonomous relative to what decisions it can make. Some of the provinces are reasonably large. Alberta happens to be fair-sized with a population in the range of 5 million inhabitants. Some of the other provinces are very small. When you get to Nova Scotia, as an example, the population is less than a million.

Provinces struggle with their fiscal responsibility to deliver healthcare in an effective way. They claim they do not have enough money being transferred from the federal government. Another possible influence is that all the money is allocated and mandated largely through a political system; much like everywhere else. The political system goes through changes, usually every four years when we have elections. We’ve seen the healthcare priorities change from election to election as new governments come and old ones go.

It goes without saying that IT in healthcare usually does not work well in a four year cycle. Getting consistency has been, in some cases, difficult. In other cases, Canada has been able to stay the course. The IT undertaking in healthcare that has been going in the same direction for five to eight years seems to have more of a head a steam and is delivering better results, but it is a challenge.

HMT: Given that there is so much power within individual provinces, how does the federal government influence health IT in Canada?

Folker: You are correct about the provincial power. A fair number of problems are created because some of the smaller provinces had trouble affording anything in IT, even as IT started to become prevalent in healthcare. Some of the larger provenances had difficulties spreading the word regarding IT best practices. The federal government stepped in and created an organization called Canada Health Infoway.

Rather than just dole out additional money to the provinces, the federal government created Canada Health Infoway to stimulate a number of IT initiatives that many felt were needed within each province. They assisted a number of the provinces in the undertaking of IT projects and helped to fund them. In a lot of cases, they would fund 50 cents on the dollar, but it was a great program to stimulate and fund activity in a number of provinces.

If you visit the website, you see the federal government delivered a very valuable blueprint that outlines thinking relative to how to create an IT strategy and what it should look like to be effective in delivering healthcare. A lot of provinces adopted that blueprint and a lot of countries around the world have used that blueprint as well. They might have made changes to it to fit their own unique needs, but it is highly recognizable on a global scale.

Orion Health’s technology lines up very well with the IT blueprint created by Canada Health Infoway. We are a very close fit so we have provided IT services to a number of provinces. In fact, our technology stack is the basis for their electronic health record.

As trends in healthcare continue to change, we understand that we have to always be on the lookout for new IT blueprints, no matter their origin, and consider how we might need to modify our technology, or how our new technologies may allow modifications to a pre-existing IT blueprint. You have to discuss these sorts of considerations with as many partners as possible as well. You cannot be flat footed. You cannot be alone. If you are either, you won’t be in a position to help anyone.

HMT: Can you give me a brief history of Alberta Health’s work with Orion Health?

Folker: Originally, Alberta Health had, to a large degree, IT in the individual hospitals, so there was a fair amount of IT being used within a given hospital, but there was very little being used outside its walls. 

For the most part, patient records were some combination of some electronic records and some paper information. Most of the technology systems were not linked. So hospital A and hospital B would have their two IT environments, but they weren’t linked.  They couldn’t share any data or efficiently move the patient from one site to the other. Most of the provinces in Canada operated the same way, and each one looked at how it could start to consolidate healthcare information into an environment that would be accessible to a variety of providers. This sort of environment makes population health a very tricky task. Alberta Health came to Orion Health in the very early stages of their planning with the hopes of creating potential long-term solutions to these issues.

HMT: What were Orion Health’s functions in those early stages?

Folker: At that point in time, Orion Health had two capabilities that seemed to fit with Alberta Health’s strategic direction very well. 

The first one was the integration capability. We had Rhapsody, which was an integration engine that allowed you to extract data from a disparate system and put it into a centralized repository.

The second technology capability from Orion Health was providing a portal that not only collected data in a central repository, but also allowed providers to view data no matter where they are on the portal. A physician, a nurse or a tech had the capability to view an Albertan’s medical profile, which would help them immensely with providing ongoing care.

We were highly successful for one reason: We incorporated a number of their end-users into the decision-making. We had a strong contingent of physicians that were providing input and guidance as we were laying down that strategic road where we wanted to travel. That served us well on this journey of creating a provincial network that allows for the collection of patient data and then to be able to display that data, on demand, to a wide variety of providers. No matter where they are located, we could assist them in delivering better standards of care to their patient. 

HMT: That leads me to ask about Alberta Netcare, the provincial EHR. Where
does that project currently stand?

Folker: Today, it is very functional and very sophisticated, but it took a while to get there. If you were setting out to create such an EHR today, you would probably look at it a little bit differently and would probably manage it differently than they originally thought. Over the past eight years, the EHR was searching for any meaningful information, adding on this, and adding on that. It’s now the leading EHR in Canada. That’s due to the maturity of it as well as the continued drive forward to make even more advances. There is still some work that is left to be done at coordinating the collection of data that happens in the physician’s office in the EMR and connecting those EMRs to the overall Netcare network, but with any IT project, there is always going to be a few things like that that you want to do in the future. 

HMT: Based upon this work, can you state Orion Health’s vision of the future of Netcare’s capabilities?

Folker: Well, once you can get patient data formulated into a central repository, or it could be repositories, you have a list of capabilities that people will start to look at and want to understand, like population health. Centralized repositories would be able to look at a population of a chronic disease, such as diabetes, or a combination of patients that would have two, three or more chronic diseases. You would be able to start to look at the care process that you provide to that population and whether or not that process should be changed. You are also able to look at whether or not you are getting satisfactory results with that care process. 

A physician might want to look at their population to determine if, in fact, they are providing the right levels of care, or what types of patient populations that they are providing; some with chronic disease, some without. Being able to look at population health from different angles and the results that can come out of that is astounding.

HMT: In America, one of the things we typically see in healthcare when caring for a patient is that the treatment may be somewhat disjointed at times. A patient may need to see a family practitioner and multiple specialists and then undergo specific treatments at different hospitals. Is this situation common in Canada as well? 

Folker: Yes, but what happens when you have the basic framework of a Netcare is that you can integrate care plans, because patients can be tracked throughout the whole series of care events they go through. This approach improves the patient experience, and it will have dramatic effects on the outcomes from a safety standpoint. 

HMT: Can you talk a little bit more about how Alberta Health has become an exhibit site for other facilities?

Folker: Over the years, we have had tremendous numbers of people visit Alberta Health and, in a way, it is humbling because we visited so many organizations when we were working to develop Alberta Health. When Singapore was looking at implementing an EHR, they visited Alberta Health to observe, ask questions and talk to a number of users who were IT people. It was a wonderful experience for us all. Based upon what they learned, they decided to use Orion Health technology as the backbone for their project. We have had similar experiences with Sutter Health in California, the State of Massachusetts and the State of Maine as well.

Our success rate in terms of the number of perspective clients that have visited Alberta Health is probably in the 90th percentile. Anyone who ever comes here is very impressed by the whole environment and Netcare and what it has done for Alberta Health’s patients. We love sharing how our tools work.

HMT: With such a comprehensive network, the opportunity for data mining and analytics must be compelling.

Folker:  Well, as you know, analytics takes on different meanings to different people but, at this time, the world of analytics is exploding. The capability to extract data from a data source, look at it and use that data to provide different levels of care is becoming increasingly important. 

Alberta Health is spending a fair amount of time and effort relative to the world of analytics. They are trying to determine how they can mine and use the data they possess. It is very interesting, because everyone has differing opinions of what analytics is and what it can do. Today, you might use analytics to look at patient population, but as we continue to develop our analytic capability, we will be able to drill directly down to a single patient – and that’s exciting.

An interesting thing that is starting to come up now in terms of analytics is the whole viewpoint relative to the patient experience. One aspect to talk about is the provider experience and how IT has enabled a number of things they do, and you talk about it from the technology company’s perspective (Orion Health); we are a technologies company and where we are going and what the goals will be.

The other aspect that is starting to play a role is how people want to understand the patient experience; how “Joe Blow On The Street” is impacted by IT decisions.

There is a pretty strong reference to that in the Canada Health Infoway website. All of a sudden, they have started to switch gears and focus on the impacts IT has had on the patients themselves. That is one of the other aspects that is starting to become prominent in Alberta Health and will form a component of Orion Health’s continuing conversations with them.

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