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Quebec aims to link healthcare providers across province

By Jerry Zeidenberg

MONTREAL – Quebec has launched a project to connect the disparate computer systems used by healthcare providers across the province. The goal is to improve information sharing among hospitals, long-term care centres and community care organizations, including physician practices.

As part of the project, Quebec awarded a contract to Purkinje, of Montreal, to supply its integration engine over the course of the seven-year effort. Purkinje, who partnered with Enovacom to provide the integration platform to clients in North America, is said to be a powerful engine that quickly converts information from one system into data and formats used by others.

Interoperability, and getting disparate computer systems to talk to each other, is a challenge faced by many regional health authorities across Canada.

In this way, doctors and nurses at a hospital in Sherbrooke, for example, will be able to see the medication lists of patients from local nursing homes, or the lab test results for patients who have been referred by from community clinics. All of these providers may use different computerized solutions that typically have trouble exchanging data.

The integration project is designed to make healthcare decisions faster and more accurate, thereby improving the quality of care and reducing sky-rocketing costs.

“Healthcare providers are often re-keying data into their own systems,” commented Alain Larochelle, vice president at Purkinje. “This is not only time-consuming and inefficient, but it often takes time away from patient care,” he observed.

It can also lead to errors, when data is incorrectly keyed.

Moreover, clinicians who can’t see recent test results often order new tests, resulting in duplication and adding to the cost of care. This practice also results in treatment delays.

The automated sharing of information is expected to reduce such delays, and to improve efficiency and quality.

“It has been difficult to share information in the past,” said Larochelle. “Building integration between systems required a lot of programmatic expertise at the healthcare organizations, expertise they didn’t always have.”

Quebec has more than 100 hospitals in 33 regional health authorities, several hundred long-term care centres and thousands of doctors in clinics. It was a tall order to expect them to have expertise in constructing interfaces for integrating healthcare data.

Larochelle said the difference now, with the Purkinje/Enovacom integration engine, is that the solution is easy to use and doesn’t require a lot of technical knowledge on the part of the users.

“It has a visual interface that’s much easier to use,” said François Carignan, Purkinje’s president. “You don’t need skills in Java or .Net to build interfaces between systems.”

Purkinje has already started training staff at the Centre de développement et d’opérationnalisation (CDO), the agency that will assist in rolling out the provincial acute care electronic medical record, called Cristal-Net.

The strategy is to deploy Cristal-Net at all healthcare centres that haven’t implemented an EHR, or where an existing EHR hasn’t been working well.

The CDO team will also lead the deployment of the integration engine, with the assistance of Purkinje. The first step, Larochelle noted, is for Purkinje to transfer knowledge about the integration platform to the CDO, so its staff members are well versed in the technology and become autonomous for the roll-out.

In addition to linking patient records, lab results and PACS, the integration platform will connect to financial system data and billing systems, procurement, EMPI and schedulers, the Ministry of Health, and to an upcoming data warehouse.

Purkinje is itself a long-time supplier of electronic health record solutions to hospitals and primary care providers in Quebec.

François Carignan noted the company currently has a number of hospital customers in the province, and in some areas of Quebec, such as Bas Saint-Laurent, Purkinje is the leading supplier of electronic systems to primary care clinics.

The Enovacom engine is either integrated or in the process of being integrated into Purkinje’s products, including a fully web-based, closed-loop medication management solution, its ambulatory EMR and online appointment bookings.

Larochelle said the integration platform offers commonly used solutions like HL7 v2 and v3, but also more forward-looking technologies like FHIR and XML. However, users don’t have to be experts to deploy them.

In areas like Bas Saint-Laurent and Gaspésie in Quebec, or some areas in Ontario, where Purkinje systems are widely used, clinicians will soon be able to target groups of patients for specific types of healthcare – such as COPD or diabetes. The platform will link all providers and enable the use of standardized healthcare protocols to the benefit of the patients.

The Purkinje system is also optimized to track the social determinants of health, such as a patient’s working and living conditions, as well as the traditional vital signs and symptoms.

Its integration platform opens up the system to usage by a wider variety of care-givers. “It’s not only doctors and nurses who can use the solution, but social workers, dieticians, respiratory therapists, and others,” said Larochelle. “They’re working in collaborative teams, not unlike what Ontario’s Health Links program aims to achieve: a standardized way to efficiently connect various providers.”

He said Quebec aims to have collaborative teams of this sort working together at hospitals, long-term care facilities and community care centres across the province. But it’s necessary to provide a powerful and intuitive integration platform – such as the one Purkinje is delivering – to tie these caregivers together and allow them to share their information.

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