Building ‘One Canada’ for healthcare: How a new national trust framework will end the era of the fax machine

With the second reading of the Connected Care for Canadians Act completed in the Senate and the almost certain passage of the legislation requiring vendors to conform to interoperability standards, Canada Health Infoway is laying the groundwork for a nation-wide Connected Care Trust Framework (CCTF) and proposing a pilot project to demonstrate value to health authorities across the country.A trust framework is a set of agreed upon standards, policies and protocols that enable secure, reliable and authorized digital interactions or data sharing between organizations using the FHIR standard.Trust frameworks in the banking industry, explains Abhi Kalra, executive vice-president of Canada Health Infoway, make it possible for customers who bank with TD to walk into an RBC branch and use their debit card to withdraw cash from the ATM. In the U.S., the Trusted Exchange Framework and Common Agreement, better known by its acronym, TEFCA, serves as a nationwide system for health information sharing.The U.S. began work on TEFCA seven or eight years ago and its eHealth Exchange, a qualified health information network under TEFCA, currently facilitates more than 1.35 billion transactions of patient information every month. Until recently, it was primarily a provider-to-provider exchange, but it is now scaling up to allow patient access to their health information.“The good news,” said Kalra, “is that the private sector vendors who started it all are the big hospital information system vendors–Epic, Oracle and Meditech–that also operate in Canada and they’re already familiar with TEFCA.” That leaves Canada’s EMR, long-term care and virtual visit software vendors who will need to comply in Canada.With the proposed CCTF for Canada, “patients can receive care irrespective of where they go without any gaps in their information,” said Kalra. “Whether it’s your family physician or a walk-in clinic, they’ll have a full history on you. Similarly, if you go to the hospital, the triage nurse will know the last time you went to your doctor, when you were last immunized and what your allergies are.”Information exchanged needn’t be limited to a patient summary. “That’s just one piece of information that could be shared,” said Kalra. “You could also share referrals, diagnostic results and immunizations. There could be numerous use cases. The U.S. started small and now we’re seeing the scope of use cases expanding because the underlying framework is in place.”The trust framework has relevance both provincially and nationally, noted Kalra. The medical record follows the patient whether they’re home in Windsor or on the road in Ottawa or Niagara Falls. It’s especially useful at a national level for patients from the Yukon or the Northwest Territories who often seek care in B.C. or Ontario.In Prince Edward Island, where there is a lack of specialists and as many as 10,000 or more fax or paper-based referrals out of province every year, family doctors using the CCTF would be able to have visibility into the availability of specialists across the Atlantic provinces and seamlessly transfer patient information, said Kalra.Use of the trust framework does not limit the number of EMR vendors as long as they are in compliance with Bill S-5, the Connected Care for Canadians Act. In Ontario, that means all 12 OntarioMD certified EMRs could continue to operate and be able to share patient information.With the right legislation and some initial incentives to motivate the market, Kalra is confident that the CCTF could be operational within 24 to 36 months. “The U.S. has been at it for seven or eight years. In our case, 50% of the work is already done because the hospital information system vendors are already compliant. We just have to focus on the other care settings. That’s what’s giving me confidence.”Canada Health Infoway has been raising awareness about the CCTF through meetings with health authority leaders across the country and is seeing some interest, said Kalra. “The territories badly need something like this because it’s about better patient care delivery, efficiency, equity and improved patient and provider experience,” he remarked.“When we talk about building One Canada, the CCTF is about building One Canada for healthcare because there’s no better way to connect 13 different health systems.”The CCTF, said Kalra, can be promulgated by Canada’s health ministers as the way to connect 13 jurisdictions, or adopted through persuasion by the country’s provinces and territories following a successful pilot.The next step is the release of a blueprint later this month or next defining the ideal state of a trust framework for Canada. “Once we publish it, I’m sure there will be a lot of feedback and hopefully, a lot of support for it,” said Kalra.

Building ‘One Canada’ for healthcare: How a new national trust framework will end the era of the fax machine

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