This report is one in a series being prepared for the various Ministries of Ontario's provincial government that capture the addresses of residents and businesses opearating within the Province.

The focus of all of the reports in this series is Address data and its uses throughout the Province's operations. While this should be a relatively uninteresting subject, it takes on considerable significance given the most recent estimate of the aggregate postage costs incurred by the Province at $450,000,000 annually and the fact that there are many instances of errors and ommissions that, in each individual case, can be excused, but taken together, are clearly a significant problem that impedes the effectiveness and efficiency of many of the Provinces operations.

This file, at this early point in time, is simply a set of Observations and their resulting Ideas, that are being considered (and well received) by various potential Contributors to the solution of some of the problems that have recently been identified in Canada's Health Care systems.

These Ideas are:

• Culled from the more important insights gained from known situations during the past decades.

• Shared amongst an initial set of Interested Parties that may be at least exploring the extent of their opportutinites to develop and operate a new generation of Information Technologies for the benefit of all parties involved in the provision of Canada's Health Care.

• . . .

Typographic conventions in use within this file include:

• Extensive use of lists since most of this material is in a very early state and as such is best presented in point form.

• 'TitleBars' that have been added to assist browsers in navigating the file as efficiently as possible. Alternatively, it is quite possible to simply scroll down through this file.

• The use of white space to separate the apparent 'chapters' of this file.

• . . .

This first Version of this file is little more than an outline of what is to come, both in its electronic and printed formats.

In practical terms, the electronic version is most up-to-date, being a "work-in-progress" that is receiving considerable attention and feedback from the various audiences that are starting to consider the enclosed ideas.

Periodically, printed versions are produced in order to provide 'subscribers' with a current 'status' report. This also ensures that the benefits of the color graphics are available to subscribers, rather than having them struggle with the limitations of the output that is produced by simply printing the HTML versions they receive more frequently.

... Under development. ...

Tables of Contents

This area of the file needs to be tailored.

Summary

Considerable work is now being undertaken as a result of the following statement...

At this time, Interested Parties known to have a desire to discuss their possible participation include:

• Canada Post. ("Honest broker" address management.)

• Epost. (Secure electronic data transfer)

• The National Association of Major Mail Users. (Shared Expressed Informed Consent - Privacy's "holy grail".)

• Bell Canada Enterprises and its pertinent subsidiaries & Telus. (Utility triggered Address maintenance)

• Shopper's Drug Mart. (Integration of electronic prescription records withing the Patient's "Electronic Sefety Deposit Box".

• Toronto based members of Ontario's medical profession.

• Various Ministries and Agencies within the Province of Ontario. (so far, apparently under-represented)

• DataFix (Canada's largest Trusted custodian of third party data.)

• . . .

The following material is currently included in this introductory comments for two reasons.

• First, it makes the point that the real art is in the matching code, not simply the access to another data set, a point that can be reinforced with other Electoral case studies.

• Second, it appears that Moh is right back where they started in 1994, asking the MoF to help. This, sadly, in spite of having spent considerable time and effort in the mid 1990's to study and formally recommend the actions documented in the referenced MoH report.

". . .

Further of our meeting on Friday, I reviewed the 'Address Accuracy - Proof of Concept Report'. It's interesting that while the report indicates that improvements to the MOH file could be achieved using commercial databases, there seemed to be more emphasis placed on the complexity of the matching process and that there are accuracy problems associated with commercial databases.

There may be an opportunity to advise MOH that DataFix was able to address there concerns as part of the very complex matching process for the Ontario Property Assessment Corporation that would be similar to their needs.

The matching process completed for the Ontario Property Assessment Corporation in 1999, demonstrated that DataFix can take disparate data sets, perform the required matching logic and produce a scoring matrix to evaluate the quality of name and address information.

The process involved matching the OPAC voter information (8,573,690) against the National Register of Electors file (6,989,477), Canada Post's National Change of Address file, the Info Direct telephone database and the Ministry of Consumer and Business Services file of deceased individuals.

Using these definitive data sets, OPAC was able to determine with a high level of confidence where the information on their file was correct, thus allowing the corporation to focus its outreach program more effectively. In this particular example, OPAC was able to save $5 million during the 2000 enumeration.

. . ."

Findings

This Findings ("Found") section of the file is just starting to be developed.

As can be inferred from the preceding MenuBar, this Findings section has three significant sub-sections. Specifically, items are clustered ByTime, ByTopic and BySubject.

• Background information, in particular, provided to ensure that the bulk of the material in this file is presented in an effective context, is distributed throughtout the major chapters (Findings or 'Found', Conclusions and Recommendations) of this file, relying on hyperlinks for effective navigation and presentation.
  
  
• A Status (ByTime) section which encapsulates all material in proper chronological sequences, further clustered under the headings of Forecast (Future), Present and Background (Past).
  
  
• A ByGroup section which notes only the active items of discourse by participants.
  
  
• A BySubject section which reorganizes accumulated material by Ideas or Themes or by major Classification categories such as the DeweyDecimal or LibraryOfCongress systems.

In this case, the MenuBar is 'opened' to show the components of ByTime. This is done for the convenience of this file's users, who seem to follow this path, than the others. Of course, the components of the other sibling categories will appear 'open' on their own sub-pages. Finally, note that some of the major chapter names that appear in the titleBar have been replaced with '...'. This dots remain as valid hyperlinks. Their names have just been reduced soley to conserve screen space.

Time:

The following list of items is nothing more than an initial point-form outline of the material that should be collected, verified and organized for presentation to the various audiences concerned with the quality of Address data in Ontario's Ministry of Health, as well as its effective and efficient processing.

. . .

• Recently, during the winter of 2004, the Ministry of Health approached the Municipal Property Assessment Corporation (MPAC), enquiring about the possibility of matching the data that MPAC has with the data that MoH has.

  • Interestingly, the response from the MPAC people, that "they do not do matching", (a service they acquire from DataFix) is absolutely consistent with the findings that resulted from the extensive studies undertaken by MoH during the mid 1990's within the then active Registration Enhancement Program Project.

  • . . .

• During the first two months of 2004, a 'melanoma' diagnosis, initiated a series of medical treatments that involved a considerable number of medical staff, based in a couple of clinics as well as the facilities of three separate Toronto hospitals. It is most important to note that the quality of the medical care can only be described as "superlative" and "world class".

  • That being said, one area of obvious improvement that remains is the efficient collection of pertinent data from patients. Not only was it apparent that the current practice of setting up a Patient record at each of the three hospitals (Women's College Hospital, Princess Margaret Hospital, and Mount Sinai Hospital) was redundant, but a subsequent attempt by support staff to contact the patient made it clear that data entry errors (wrong telephone number) in one of the records actualy could introduce possibly dangerous delays into the system.

  • The benefits of a modern approach to data capture and sharing have been recognized. The ...

  • . . .

• Effective record keeping is critical to the Patient's well being.

  • Current practice may include charging patients inflated copying fees.

  • A Doctor's records were impounded upon death, depriving patients of essential information.

• A patients perscription records can be integrated. (Shopper's Drug Mart)

• The Medical Information Bureau case study needs to be updated.

  • Insurance eligibility?

  • FOI against a US file was a severe problem?

• . . .

  • . . .

Background:

The following extracts from Canada Health Infoway Inc's Annual Report 2003 provide additional information pertinent to these matters.

WHY EHR SOLUTIONS?

infowayand its Members have defined an EHR as a secure and private lifetime record of an individual's key health history and care- The record is available electronically to authorized health care providers and the individual anywhere and anytime in support of care. Today, health records are largely paper-based and often not easily accessible to the right health care professional at the right time, regardless of where Canadians live or where they are attempting to receive care.

An EHR, on the other hand, would give authorized providers rapid access to their patients' complete, up-to-date medical records, Including physician visits, hospital stays, diagnostic tests, prescribed drugs, and laboratory tests-It would do so while safeguarding patient privacy, A network of interoper-able EHR systems in Canada-one that links clinics, hospitals, pharmacies, and other points of care-wiil help improve Canadians' access to health services, enhance quality of care and patient safety, and make the health care system more efficient.

CANADA'S EHR CHALLENGE

Numerous initiatives are planned or underway In Canada to create components of EHR systems, but most are focused on specific services, regions or hospitals. These initiatives are in early stages of development, which provides an excellent opportunity to align various approaches and build compatible systems based on a common blueprint and common standards. Doing so will speed up development, avoid duplication of effort, reduce costs, and minimize risks.

In fact, the cost of building Isolated systems is enormous, and when built, there is little likelihood that those systems could be linked m the future-We estimate that the cost of putting In place the basic elements of Interop-erable EHR solutions in Canada using a collaborative approach is approximately $2.5 billion; in the absence of collaboration, the cost would be considerably greater.

Ensuring the protection of privacy in an EHR environment-how health information is collected, used and disclosed-is fundamental to Infoway's vision and its entire approach to EHR solution development- Privacy considerations are therefore important criteria In the selection of projects for investment.

Another significant challenge for EHR solution development involves working with users to ensure that solutions meet user needs and help them do their jobs more effectively and efficiently. Giving health care professionals the tools and information they require to provide quality care is not enough; they also need support to help them integrate the technology into their regular activities. Accordingly, Infoway-through Its partners and investments-involves health care professionals during the design and implementation of EHR solutions.

infoway integrates knowledge management and change management activities into each investment to facilitate EHR implementation and promote collaboration. It Is investing in projects to share information, highlight best practices, develop toolkits and other resources, and learn from the wealth of experience in Canada and abroad.

THE BUILDING BLOCKS: - INFOWAY'S 18-MONTH PLAN

In its business plan, infoway identified five key building blocks for compatible EHR systems:

1. Infostructure, which includes the definition of a common solution architecture and common standards needed to ensure the interoperability of systems and the reuse of common components

2. Client and provider registries, which are electronic mechanisms for identifying patients and providers

3. Diagnostic imaging systems, which allow specialists and physicians to view patient test Images and reports on-line

4. Drug information systems, which allow physicians to electronically send prescriptions and pharmacists to view orders on-line and electronically confirm the filling of a prescription

5. Lab information systems, which allow specialists and physicians to view lab results and reports on-line

Conclusions

• Ontario's residents "Can, Should and Will" help maintain their records.

  • When? is the only question. (The next generation is technically more adept.)

• At this time, there appears to be sufficient promise to justify the formation of an Enterprise with multi-diciplinary representation, that may undertake the development a new generation of Information Technologies, not just for Ontario, but for the entire Canadian Health Care network.
  
  Obviously, much needs to be done, before participation in such an undertaking can be properly justified. That being said, this file should be considered as a "work in process" that is an 'invitation' to start disscussing the nature of the opportunities, and how they can best be exploited.

• . . .

Recommendations