Countries around the globe are struggling with the rising cost of delivering health care. In the developed world, this trend is enforced by aging demographics and emerging forms of expensive medical interventions. Disease prevention, early disease detection, and evidence- based disease management are key for keeping health care systems sustainable. Electronic information management has been recognized as a central enabler for increasing the quality of health care while controlling the cost of delivering it. Secondary care facilities (e.g., hospitals) and laboratories have made use of electronic information systems for decades. However, the primary care sector has only recently begun to adopt such systems on a broader scale. The benefit provided by each system in isolation is limited since citizens generally receive their care from a multitude of providers. Health care information systems need to interoperate in order to enable integrated health information management and consequently attain the declared qualitative and economic objectives. Many industrial countries have begun to create common infrastructures for such an integrated electronic health record (EHR) (Blobel, 2006). Different approaches exist, ranging from centralized databases to highly distributed collections of mediated provider-based systems. This chapter describes the architecture of the Canadian infrastructure for health information management, which can be seen as a compromise between a fully centralized and a fully distributed solution. While in Canada the delivery of health care is a matter of provincial territorial authority, the health ministers of all provinces and the federation have created a joint organization called Health Canada Infoway with the mandate to develop an architecture for and foster implementation of a joint interoperability infrastructure for EHRs in Canada. The second major version of this architecture has now been released, and provinces have begun to implement it. The solution is based on the paradigm of a service-oriented architecture (SOA) (Erl, 2004) and embraces a range of domain-specific and technical standards. It leverages and integrates existing investments in health information systems by making them available through interface standards-conform interface adapters. The Canadian EHR architecture has received attention beyond the Canadian context. This chapter reports on this architecture, its enabling technology paradigms, experiences with its implementation, and its limitations.
Key Terms in this Chapter
EHR Infrastructure: A collection of common and reusable components in support of a diverse set of health information management applications. It consists of software solutions, data definitions, and messaging standards for the EHR
Health Information Data Warehouse: An information system to compile, aggregate, and consolidate EHR data for reporting and statistical or research analysis
Registry: A directorylike system that focuses solely on managing data pertaining to one conceptual entity.
Health Information Access Layer: A gateway that acts as an abstraction layer to separate PoS applications from the EHR Infrastructure. It is made up of service components, service roles, information models, and messaging standards required for the exchange of EHR data and the execution of interoperability profiles among EHR Services
Electronic Health Record (EHR): Provides a secure and private lifetime computer-based record of a patient’s key health history and care within a health system.
Domain Repository: A component of an EHR Infrastructure that stores, manages, and persists a clinical subset of data pertaining to a specific domain
Point of Service (PoS) Application: PoS applications are used by authorized caregivers to view and navigate the EHR of a patient/client.