Collaborating with the Private Sector

On Tuesday, February 17, 2004 Infoway presented a videoconference Information Session to more than 230 senior health care information solution providers in Toronto, Vancouver, Montreal and Halifax.

This event hosted by The Information Technology Association of Canada (ITAC) and The Canadian Information Trade & Technology Association (CHITTA) allowed Infoway to share it's mandate, business plan, program & project developments and engagement processes.

The presentation is available for download.

Question & Answer Period:

Question 1
Have you considered the establishment of a database for private resources so that your partners and other stakeholders could communicate with each other re issues like human and technical resource shortages? Would this be a good way of getting people connected?
- Wayne Bell - CEO, Digitial Group of Telehealth Companies

Answer 1
With respect to the database of private sector resources for Telehealth investments, partners are identified in jurisdictions and may already have some resources in place. As we move further into Telehealth, we will do a review of resources. We will be reviewing available resources and building a database as we go. You will find that some jurisdictions eg: north of 60, have already selected some of their partners and have asked infoway to act as a catalyst.
- Susan Hyatt - VP, Partnerships & Alliances, Infoway

Question 2
Will there be an updated version of the architectural blue print released in Q1 of the Calendar year?
- Heather Jones - Oracle Healthcare

Answer 2
We need to update the data requirement around privacy & security perspectives. We will ask the Board for funding to do that particular work around privacy and security. We plan to do a drill down to a new level of detail to specify various interactions between components and define the components in a little more detail from a functional perspective, so that we have a good sense of what services each of those components is required to do.
- Dennis Giokas - Chief Technology Officer, Infoway

Question 3
Will you be posting an organizational chart?
- Heather Jones - Oracle Healthcare

Answer 3
We went through an intensive reorganization in the summer and have now reached a steady state. An organizational chart will be put on the web.
- Myrna Francis - Interim President and CEO, Infoway

Question 4
Can you elaborate on collaborative tools that will become available for private sector members to use? IRIS ?
- Heather Jones - Oracle Healthcare

Answer 4
We would, in the context of standards, like to create a tool that can serve two purposes:

  1. Test for interoperability & compliance to that standard
  2. Provide easy mechanisms for all developers, public or private, to take the routines out and know how to create & decompose the HL7 messages and integrate those into their applications so they don't have to be worried about the actual message structure. We currently have a pilot going in client registry and dependant on the success of that program we will decide whether or not to expand. Stayed tuned,

- Dennis Giokas - Chief Technology Officer, Infoway

Question 5
Is there any geographic consideration with regard to distribution of investments and a way of operating whereby you go to where the solution is and build up and develop it without geographic consideration?
- Paul Hill, MediSolution

Answer 5
Not one investment decision made out of the $224M was based on political or geographical allocation reasons. That was the way we set up our business model. The benefit is that there would be activity across the country within the the 6-year timeline.
- Myrna Francis - Interim President and CEO, Infoway

Question 6
Do you think that the first deal in a certain area might give an unfair advantage or disadvantage? How will you preserve a competitive market place?
- Unidentified Speaker

Answer 6
Consolidation will happen. For example, if there are 4 or 5 major PACS vendors, hospitals will decide who and what they will want, you need to sell your wares to them. You decide how to compete. We will set out in our investment what we would like to invest in a shared PACS solution with a certain number of facilities. You decide how you want to modify your product offering to be a better match to the investment. Who ever sells the organization wins the job but we will need adherence to standards.
- Myrna Francis - Interim President and CEO, Infoway

Question 7
What are Infoway's plans with regards to standards in Telehealth?
- Director, Canadian Society of Telehealth

Answer 7
In each of the different investment areas, standards are a key as the industry is standardless. The investment direction will focus on standard development in Telehealth and piggy back on work already underway.
- Myrna Francis - Interim President and CEO, Infoway

Question 8
For project investments are there rules around IP rights? Does Infoway share in those rights or is it between vendors and original project sponsors?
- Steve Papagiannis, CA, Toronto

Answer 8
Infoway will not own IP. Infoway will come and go while vendors, provinces and other jurisdictions carry on.

Infoway invested in some projects where 3 or 4 provinces had been working together for some time to develop a solution and already owned the IP. That means that all the governments of Canada can have that IP. Where you have commercial IP considerations, you cross into the realm of Partnerships & Alliances. Parts of a bilateral agreement negotiation are the rules around IP, Pricing, licensing, etc. That's assuming it's a replicable solution.

As representing the national market, we will be aggressive regarding National Licensing Fees, Best Pricing and structuring fee arrangements specific to Canada vis-à-vis US business metrics.
- Myrna Francis - Interim President and CEO, Infoway

Sue Hyatt added:
We meet collaboratively every quarter with the CIOs of Health in all jurisdictions. We are having conversations with them to look at the market as being Canadian and not just regional.

Comment from Steve Papagiannis:
There could be international distribution.

Comment from Myrna Francis:
It's moving toward:

  • Global Standards
  • Global Solutions
  • Marketplace
  • Integration is the key
  • There is a large scale & cost of sale advantage to the vendor

My question to you is:
What are the vendor concessions?
What is the Quid Pro Quo?

Question 9
Regarding the Partnership & Alliances model, where do the academic institutions fit?
- Lisa Meginbir, BCIT, Vancouver

Answer 9
The key issue we all need help with here is how to build capacity in health IT. We need the public, private and academic sectors to come together as they have in other sectors to address the capacity need. We are now starting to develop a strategy through the Industry Alliance team in my group. Myrna has had initial meetings with the academic community, but we need more input. It's an issue that's on the agenda at COACH and we would like to work in partnership with you and others to develop a Canadian action plan.
- Susan Hyatt - VP, Partnerships & Alliances, Infoway

Question 10
How are you going to decide what data set or record shape will serve the various purposes? Will you adopt some sort of dynamic XML model? “First-in” vendors will try to establish proprietary code or definitions as a standard. How will you manage for a level playing field?
- Peter Odehnal, Health Dynamics, Vancouver

Answer 10
Providers will provide the definition of the EHR data priorities. It's up to them. We are aware of the issues around vocabularies and maintaining semantic consistency across systems. We are looking at technologies to make that possible and those tools would be imbedded in the HIAL creating some data abstraction for those applications. XML will be helpful but is not the whole solution. As for the “First-in” vendor issue, we are committed to the promotion of a transparent, open and level playing field.
- Dennis Giokas - Chief Technology Officer, Infoway

Question 11
With regard to the PIN program in Alberta, and standards, behind the funding, is there a belief that this project will be rolled out across the country? I have two concerns:
  1. The choice of the drug data base is First Data Bank. Do we believe that will be adopted by all provinces across the country?
  2. With regard to the architecture, the way the EMR connects to the network, has specific architectural definitions that seem pretty specific to that initiative. Do you believe that will be the de facto standard for the rest of Canada?

Dr. Fernand Taras, Purkinje, Montreal

Answer 11
Is PIN going to be the only drug information system solution rolled out across the country? No. In all investment areas we expect about three solutions. For example in Diagnostic Imaging there will be as many solutions as there are vendors selling PACS. There will be more than one in Drug Information Systems We have found that because you are selling to your traditional buyer, they want a choice, not a single plug and play solution. What we will ensure is that the various plug and play solutions meet appropriate standards. The objective is not to create monopolies but to ensure competition. As for the specifics of a program , I suggest that you deal for instance with a Program Director like Paul Tier in Drug Information Systems. As to PIN being a de facto standard, there is a standards project underway with regard to drugs. We are looking to standards that hit pan-Canadian capability and not a de facto anything.
- Myrna Francis - Interim President and CEO, Infoway

Follow on comment from Taras:
It is a challenge for the vendors when we have to meet all the various standards requirements of all the jurisdictions in a fragmented marketplace.

Answer, Dennis Giokas:
Part of our added-value is creating a standards base so that you only have to develop one set of standards that are certifiable as far as other products you may have to integrate with. Also, the jurisdictions, in order to receive Infoway investment must also adhere to the same standards as well.

Comment from Myrna:
We believe that Canadian National Standards can become global standards. There are other countries like the UK going down the EHR track and there is thinking underway toward global standards.

Question 12
You talked about exporting Infoway standards globally, while there are some initiatives that have been going on for 5 years and are spreading internationally in the direction of IHE. IHE is going beyond DI to pharmacology and lab results in the next year. Where do you stand on what IHE is doing?
- Unidentified, Montreal

Answer 12
We are very supportive of IHE. Sue mentioned gated funding earlier and there are some funding gates in our current investments so that the solutions deployed in Thames Valley and Fraser Health are IHE compliant. I have one person on my staff that is very involved and knowledgeable and helping to shape future direction and participating in various forums like HIMSS. We feel this support of IHE demonstrates our commitment to standards.
- Dennis Giokas - Chief Technology Officer, Infoway

Question 13
I would like to comment on doing business differently. We the vendors do not like the RFI or RFP process on the whole but there is another issue in that product functionality is being defined by the RFP or RFI process. There is no real collaboration with the vendors or the medical providers. What is your comment on this? Also, what is your comment on conformance testing or certification of products not just on standards but regarding functionality of those products and involving all stakeholders to have a collaborative approach as opposed to this one way approach. Do you have any comments on this and about creation of a national conformance testing organization?
- Dennis Niebergal, Pres & CEO Clinicare

Answer 13
Mike Rigo has just joined us. He will come out to talk to you about what vendors need and want. So part of our commitment to you is to understand how you want to do business. If there is something we can do to make this easier, let's have that dialogue.
- Susan Hyatt - VP, Partnerships & Alliances, Infoway

Comment from Dennis Giokas:
We cannot proscribe for the jurisdictions how to deliver health care and what the policy for that should be, so we had to work diligently to architect a solution that could cover the whole enterprise. A solution that would work given the uniqueness in each jurisdiction and not only between jurisdictions but within jurisdictions at different levels from the ministry on down to the private primary care physicians. When we talk about compliance and conformance, it will be at the interoperability or integration level where various components will have to integrate and the example I use is often privacy policy.

I may expect a component to send me back one of three results:

  • Yes, I have access to that data.
  • No, I don't.
  • Error in the request.

The policy behind that message is for the jurisdiction to decide not Infoway. We will test conformance and compliance at that integration point but our tools will not test all the nuances of policy behind that. We will leave that for our partners to do and if there are differences between jurisdictions, that's for them to figure out and to establish how to define and test those.

Comment by Myrna Francis:
One thing we have found that is positive but on which the verdict is still out is the collaborative approach. That approach is new across the country and has not been entertained before. It is starting to show promise and benefits. One of the activities that Sue has spearheaded is bringing together the CIOs of all the governments across the country - originally to inform them as “customers”. The offshoot is that they are coming to realize that someone may have broken the back on an issue like conformance testing at a local level and through the forum other jurisdictions can now become aware and learn from the experience elsewhere.

By working together they realize they can start to get some things going and save money and time. One example is conformance testing around applications at the physician desktop, an issue that Infoway would not be involved in. If there is momentum in one jurisdiction, there is now a forum to start sharing information and experience. I think you're going to see that if there is value, it's going to go forward. As this process goes forward in the next 12 months and the jurisdictions become more comfortable with it, you may see a national approach for conformance standards. This can happen not because it was mandated but because there is now a vehicle across the country that did not exist before. That is good for the vendor community.

Sue Hyatt comments:
At the CIO forum and other Federal/Provincial tables where Infoway participates - it works both ways. If there are messages or questions that you want delivered to move this change along, questions that you would like to have tabled at a national level, then we are quite happy to table those questions or comments from a vendor perspective. Working with both the public and private sectors, Infoway can act as an honest broker, providing forums where information sharing and collaborative action can occur.

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