October 8, 1996
(Health)

New Centre for Health Information established

A new Centre for Health Information will bring various existing health information systems together to establish an integrated and comprehensive information technology (IT) system for health and social services, Health Minister Lloyd Matthews and Social Services Minister Joan Marie Aylward announced today.

The Newfoundland and Labrador Centre for Health Information (NLCHI) follows final recommendations made by the Health System Information Task Force; established jointly by government and the Newfoundland and Labrador Health Care Association in 1993. The NLCHI will implement other recommendations of the task force as part of its mandate.

The new centre will be established within the Health Care Corporation of St. John's, to be reviewed after two years. The centre will have responsibility for coordinating, monitoring and analysing data province-wide. "At the present time, various information systems exist separately from one another," said the minister. "Bringing these systems together will have a positive impact on the future of health services in Newfoundland and Labrador. Coordinating health information and databases will assist government, health providers, consumers and special interest groups in making more informed decisions about health care."

Mr. Matthews says the new centre is an essential step in health reform initiatives, enabling government to identify where health resources can most effectively be placed, based upon timely, accurate and reliable information. "The data collected will facilitate government's ability to make sound financial decisions based on proven health outcomes, ensure effective utilization of health services, and carry out sound financial and human resource planning. This is important in this province where we are challenged by our vast georgraphy and population, especially at a time when we are striving to enhance the quality of health services within our limited financial resources."

The future vision for health information incorporates a person centred approach, whereby each individual in the province is assigned a code or number so that all medical procedures, doctor visits and prescription medication can be accurately monitored. Essentially, this means health providers will be in a better position to meet individual health needs based upon that person's health history. Drug interactions, allergies and other adverse reactions, for example, can be minimized. As well, with this kind of information available to health professionals on a provincial basis, inappropriate use of the health system such as multiple doctor visits and prescriptions can be signigicantly reduced. Mr. Matthews said privacy and confidentiality will be assured in creating a new, secure information system.

In addition to health data, the new information system will incorporate statistics from the Department of Social Services. Joan Marie Aylward, Social Services Minister says improving the health of the population involves more than tracking hospital data. "There is a link between the health of an individual and that person's social, economic and educational background. For example we know that income, employment, and social support networks among others, are determinants of health. Incorporating data related to these social conditions can help government gain a better understanding of this link and set out a plan of action that will prove beneficial to the people of the province."

Ms. Aylward said the new system will prove beneficial to her department and to the overall operation of government. "It is more efficient and sensible to collaborate with other departments and agencies than to develop separate but similar systems for a client base which has obvious overlapping," said the minister. "We will be looking at areas where partnering will be beneficial to quality service delivery."

Ms. Aylward added that because the departments of Health and Social Services serve many of the same clients, an integrated approach will enhance policy development and program delivery. She said that by eliminating the cost of two separate systems, it will also allow government to better meet the increasing demand for services.

Operational funding and human resources for the centre will be achieved primarily through existing allocations from information systems in health boards and other health and social agencies.

Mr. Matthews added the new centre would work closely with the local information technology sector in the development of a health information system for the province. "Public/private partnering in this initiative is a positive step in enhancing local industry in the province and ensuring Newfoundland companies are key players in developing an information system," said Mr. Matthews.

The next step in establishing the Centre for Health Information will be to appoint a board of management to carry out the mandate of the new centre. The board will have representation from the following partners; the Department of Health, the Newfoundland and Labrador Medical Association, the Association of Registered Nurses of Newfoundland, the Medical School, MCP, Regional Health Boards through the Newfoundland and Labrador Health Care Association, the Department of Social Services, the Department of Industry, Trade and Technology, Treasury Board, other health and social agencies, consumers and the business community. The board will be appointed by the Health Care Corporation of St. John's.

Contact: Jill Sooley, Department of Health, (709) 729-1377 or Glenn Bruce, Department of Social Services, (709) 729-4062.

BACKGROUND INFORMATION

THE NEWFOUNDLAND AND LABRADOR CENTRE FOR HEALTH INFORMATION

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• 1993, the Health System Information Task Force was established by the Department of Health, Treasury Board and the Newfoundland and Labrador Health Care Association (formerly Newfoundland Hospital and Nursing Home Association).
• The Task Force was charged with developing a vision for the future of a health information technology system in the province.
• In 1995, the Task Force submitted the final report with 26 recommendations (list attached), including the creation of a Newfoundland and Labrador Centre for Health Information (NLCHI).
• The NLCHI will be mandated to carry out the other recommendations of the Task Force.
• The NLCHI will be located in the offices of the Health Care Corporation of St. John's. The Health Care Corporation will oversee the new Centre.
• The NLCHI will also incorporate data related to the Department of Social Services in recognition of the determinants of health such as income, employment, social support networks.
• Operational funding and staffing of the new centre will be realized through existing budgets. Health facilities and agencies already have monies allocated for information systems, some of which will be transferred to the new Centre. It is estimated Government spends $9.4 million in information technology in the health system (includes MCP, the Department of Health, the drug program and the regional health boards). Staff from the Department of Health will also be transferred to work in the Centre.
• The new Centre will work closely with the local information technology industry so that Newfoundland companies are key players in developing a new health information system.
• The next step in this process is for the Health Care Corporation to appoint a Board of Management. Membership will be from the Department of Health, the Newfoundland and Labrador Medical Association, the Association of Registered Nurses of Newfoundland, the Medical School, MCP, Regional Health Boards through the Newfoundland and Labrador Health Care Association, the Department of Social Services, the Department of Industry, Trade and Technology, Treasury Board, other health and social agencies, consumers and the business community.
• An approximate expenditure of $50 million in health information systems is anticipated over the next several years.
• A review of the NLCHI will be carried out after two years.

RECOMMENDATIONS OF THE HEALTH SYSTEM INFORMATION TASK FORCE

• That a population health baseline be updated annually and maintained on an ongoing basis.
• That government promote historical, descriptive and experimental research.
• That a mechanism be established to create linkages between the health information system and other sectors.
• The Task Force endorses several initiatives currently underway with regard to strengthening quality information such as; a qualifications survey of health record technicians/administrators; a Clinical Issues Committee tasked with standardizing clinical coding practices in hospitals; and a province-wide reabstraction study attempting to measure the extent of variation in clinical coding practices in provincial health facilities.
• That initiatives be undertaken to identify and develop the elements of a person-oriented information system and that these initiatives include broad representation of stakeholders.
• Given the emergence of person-oriented information as a national issue, it is recommended that a formal liaison mechanism be established with the Canadian Institute for Health Information (CIHI) to facilitate collaboration on standardization in the development of person-oriented information.
• That the province create a Provincial Health Number to uniquely identify each person as per the Report on a Unique Identifier for Newfoundland and Labrador - An Analysis of Options and Implementation Strategies. The new card will be called the Newfoundland and Labrador Health Card.
• That the use of the new health card be a requirement for all provincial residents for access to all health care interventions and the Provincial Health Number be required on all documents related to health.
• That a central registry for maintaining the Provincial Health Number be established and be accessible 24 hours a day, seven days a week.
• That the Newfoundland Medical Care Commission and other agencies be encouraged to use the new unique identifier.
• That forums and community meetings be held to encourage input, obtain advice and provide information for those affected by the proposed changes.
• That the health information system be designed with standard definitions developed using a consensus building strategy.
• That in addition to the MIS Guidelines, other national information system standards be implemented throughout the provincial health system, as appropriate.
• That the Report of the Focus Group on Human Resource Management Information Systems be used as the conceptual basis to develop data requirements for a comprehensive Health Human Resource Management Information System to be implemented across the health system.
• That the recommendations of the Ad Hoc Committee on Standard Residence Codes be implemented.
• That an Information Technology Plan be developed as part of the larger Health Information System Strategic Plan and be based on the concepts of open systems architecture and the distributed information database.
• That the memorandum of understanding between the health system and the information technology community in Newfoundland and Labrador, and any subsequent follow-up agreements, be supported by all stakeholders.
• That provincial standards be developed and maintained regarding collection, retention, security, confidentiality, access and dissemination of information. Established standards at the national and provincial levels be used to guide development of these standards (e.g., professional codes of ethics, CHRA position statements, and CIHI policies), especially where client and employee information are involved. In particular, the issues of confidentiality and data ownership must be addressed to safeguard the client's health information, while at the same time, providing access to information necessary for research and administrative purposes.
• That provincial standards be established and maintained to document and measure outcomes of health interventions in a consistent manner to support appropriate analysis and evaluation across the continuum.
• That provincial guidelines be established defining what information may be accessed for research and by whom. These guidelines should clearly identify how information may be used while protecting the individual's right to privacy.
• That a comprehensive education strategy for all users be developed, targeting the public and health professionals, with the objectives of raising awareness of the importance of quality health information and educating users on how to use the health information system.
• That personnel whose primary responsibility is with information (e.g., health records, information technology) be appropriately trained and certified.
• That a comprehensive human and financial resource plan be developed that identifies the required resources as well as strategies for obtaining same in a manner that is acceptable to health system stakeholders. Such a plan must include a consideration of existing services already being provided by agencies/organizations.
• That health informatics be identified as a priority strategy for the Provincial Economic Recovery Plan.
• That a Newfoundland and Labrador Centre for Health Information (NLCHI) be established and governed by representation from major stakeholders to oversee the continuation of the Health System Information Task Force's work.
• That the NLCHI develop an Information System Strategic Plan, based on the province's Strategic Health Plan, incorporating the strategic directions identified by the Health System Information Task Force.