Public health IT

Assessment of Panorama is released by Infoway

TORONTO – Canada Health Infoway has released an independent evaluation of its pan-Canadian Public Health Surveillance (PHS) system investment program – a project known as Panorama.

Conducted by KPMG and made available in late March, the report concludes that Infoway, in collaboration with its jurisdictional partners, is meeting most of the objectives set for the $135 million project.

Panorama was due for completion in March, 2009, and the various jurisdictional implementation projects are anticipated to be completed between 2010 and 2012. One province, Alberta, has opted not to implement Panorama.

According to the KPMG report, the areas in which Panorama meets the needs set out for it are:

• High quality, timely surveillance data at the regional, provincial/territorial and federal levels drawn from feeder systems that support health delivery.
• Outbreak case, contact and quarantine management for infectious diseases within regional and provincial/territorial levels.
• Maintenance of immunization records. However, in many jurisdictions family physicians perform a large proportion of immunizations and the availability of this data will depend on their adoption of the Electronic Medical Record as part of the broader Electronic Health Record initiative.

Areas where Panorama’s capabilities differ from the needs set out for it:
• The ability to send and receive data from laboratories. Panorama will be able to receive, but not send, data. The decision to exclude sending of data was based on the limited ability of most public health systems to receive orders via Panorama messaging.
• The ability to both send and receive data from hospital infection control was excluded. This capability was of lower priority to stakeholders and also reflected the extent to which data on possible public health risks could be readily generated and transferred by the various feeder systems used by hospital infection control functions.
• Outbreak management at the federal level. Further clarification of the intended federal approach to pan-Canadian outbreak management by the Public Health Agency of Canada (and development of related messaging), and establishment of data sharing agreements is necessary before this functionality can be implemented.
• Water quality and food inspections. Panorama has not been designed to manage water quality and food inspections. However, data from lab tests for water and food safety will be available.

It is anticipated that the PHS system will enable improvements in the management of public health in Canada in four areas:

• Improving health outcomes related to the identification and management of infectious diseases;
• Better infectious disease case, contact and quarantine management;
• Better identification, tracking and management of infectious disease outbreaks and risks to health related to infectious diseases; and
• Research and analysis to support improved preparedness for future infectious disease outbreaks and risks to health related to infectious diseases.

However, KPMG noted the Panorama PHS system is at a point where the participating provinces and territories are engaged in planning for its deployment or in the early stages of implementation, and as such, it is too early to draw conclusions regarding the benefits of the system for public health management in Canada.

Key informants who were involved in the development of Panorama and Jurisdictional Implementation projects believe that the PHS system has the potential to enable significant improvements in public health management, particularly with regard to the first three impacts listed above, on an intra-jurisdiction basis and potentially at inter-jurisdictional and national levels.

Improvements in data compilation and sharing made possible by Panorama are expected to enhance the availability of data for research and analysis in support of planning for infectious disease outbreaks and risks.

The ability of Panorama to achieve these outcomes depends not only on its functional capabilities but also on a range of other critical success factors that are largely outside the direct control of Infoway. Key amongst these are building its acceptance among end-users, clarification or establishment of business processes and data sharing agreements for interjurisdictional data sharing and outbreak management, further development of data feeder systems, and the establishment of a governance and funding structure for Panorama’s longer term sustainability.

The initial implementation strategy for the PHS program anticipated that Panorama would be developed and available for jurisdictional implementation approximately 12 months after the chosen vendor (IBM) started work, consistent with an expectation in the Agreement that development and implementation of the system would be achieved by the end of 2008/09.

This ambitious timetable for Panorama’s development was not achieved due to the complexity of the requirements and the discovery that an approach primarily based on commercially available software was not feasible, necessitating a much greater degree of custom design.

The combination of these two factors meant that the timeline was ultimately extended by approximately 18 months and the scope of some functions was narrowed compared to what was envisaged in the original definition of requirements. In turn, this delay pushed out the start and anticipated completion dates for provincial/territorial jurisdictional implementation projects.

KPMG’s analysis drew upon a program of key informant interviews with 25 stakeholder representatives (PHS Steering Committee members, pan-Canadian and jurisdictional implementation project leads and managers), six Infoway managers with management and oversight roles for the PHS program, and a review of background documents relating to the planning, management and delivery of the PHS program.

The report can be found at: http://www2.infoway-inforoute.ca/documents/Infoway-PHS%20Evaluation-Final-March%202009%20-%20EN.pdf

Background
In March, 2004, the Government of Canada provided $100 million in funding (increased to $135 million in 2007) to support the development of a pan-Canadian Health Surveillance System. The Agreement defined this system as being an electronic information system that supports the collection, collation, analysis, interpretation and dissemination of routinely collected health surveillance data through the integration of business processes, standards, information and communications technologies to guide public health action generally and to manage infectious diseases specifically.

In developing the PHS system, Infoway was required to respect the following set of parameters for the delivery and management of the program:
• Support the development and implementation of a pan-Canadian Health Surveillance System, and adopt a pan-Canadian approach;
• Invest the funding provided in the development and implementation of the solution, not ongoing operation and maintenance;
• To work in both official languages;
• As a general rule, at least 20 per cent of the development costs of PHS projects or arrangements should be funded by the jurisdictions and up to 80 percent by Infoway;
• Provide for integration with the EHR architecture and infostructure, where appropriate; and
• Build on federal, provincial and territorial partnerships, avoid duplication, realize economies and achieve interoperability.

Infoway allocated $59.9 million to the pan-Canadian solution work and $75.1 million to support the various jurisdictional implementation projects.

Infoway’s investment strategy for the PHS program provides for 100% funding of the development of the pan-Canadian projects, such as, the development of Panorama and underlying standards, 75% of the eligible costs of provincial and territorial planning for implementation, and up to 80% of the eligible costs of jurisdictional implementation projects.

Panorama is a set of applications and tools developed to satisfy the expectations set for the PHS system. It is built around six functional applications and seventeen supporting applications. The six functional applications are designed to enable the management of communicable disease cases, outbreaks, immunization programs, public health materials and vaccines, notifications regarding critical events and emergencies, and public health work tasks.

Panorama is a complex product, with approximately 3.5 million lines of code, designed to support an equally complex set of public health management functions throughout Canada.