Technology is alive and well in Alberta

Its health care network aims to assist all parties in sharing information

Though it's spelled in the lower case, the alberta wellnet is a capital gain Alberta. It has given the province the lead in deploying a jurisdiction-wide health information network (HIN). While other provinces are in the planning stages, Alberta already has some of the foundations of its HIN built and operating, at least as pilot projects. In the past few months, networks for sharing information about pharmaceuticals, cancer care, breast cancer screening, newborn registration, disease outbreaks and telehealth have either gone live or are about to go live. In effect, alberta wellnet is a cooperative of all the provinces health stakeholders including doctors, nurses, pharmacists, and the Ministry of Health among others.

Recently, contributing editor Andy Shaw spoke with the alberta wellnet's chief operating officer, John McAllister, a former management consultant and a veteran implementer of large-scale IT projects for the Alberta government.

TIG: How did Alberta get the jump on the rest of the country? Was the government a catalyst?

McALLISTER: If you cast your mind back four or five years, you may remember the Alberta government focused on health reform and created regional health authorities in the province as a result. The Ministry of Health then devolved quite a few responsibilities for the delivery of health care to those regions. But, at the same time, the government saw that those health authorities needed some support in terms of an information infrastructure. Also, a government backed study by Ernst & Young had drawn a good picture of what was needed in this information infrastructure. And the provincial auditor general's department also confirmed the need in its annual report. As a result, the deputy minister of health of the day, Jack Davis, took some fairly bold and strategic moves to create an Alberta health information infrastructure through the program we now call the alberta wellnet.

TIG: Is that what it takes to get an alberta wellnet off the ground? A champion on the inside such as Davis?

McALLISTER: Yes, but it really takes two champions. I attribute a great deal of what's been accomplished to Jack. But you also need a champion among the other stakeholders. In Alberta's case that was and still is Dr. Tom Noseworthy. Tom is a prominent physician in Alberta who has led the prime minister's national forum on health and recently co-chaired the National Conference on Health Info-Structure with the federal health minister Alan Rock. He is also a professor and chair of the University of Alberta's Department of Public Health Sciences. Tom also chairs alberta wellnet's senior reference committee. That's what you need to bring your stakeholders together -- senior, respected people participating in your key stakeholders groups.

And, as a result of that, I think we have the best relations in Canada with our physicians.

TIG: Are doctors treated differently in your province- in any way that would make them more supportive than others in the rest of the country?

McALLISTER: Not fundamentally. The pay structure is the same here as it is anywhere else in the country. But there is one difference that is very important to the development of a health information network that reaches everybody including those in remote regions. Alberta is one of the first provinces, I believe, to agree to pay physicians for telehealth services. So that has moved a major obstacle aside and allowed us to proceed with a broader range of telehealth programs, and by that we mean delivery of various health services over a distance.

TIG: What other obstacles or challenges have there been?

McALLISTER: When you are talking about obstacles, funding is always a challenge. This is a bold step for government to put money into something like alberta wellnet. Because the returns on that money are not immediate, it's an area we always have to deal with.

These sorts of things take time to build. Also, whenever you are dealing with health information about people, the issue of privacy always demands your attention. But Alberta has been working on comprehensive health information legislation that will likely be tabled in the fall. It too has had various bluemunity working on groups from the health community working on it.

As well, in the current environment, and until there is such new legislation in place, we've been taking a pragmatic approach. Our pilot projects are all consent-based. That is, we need informed patient consent before we are allowed to proceed.

TIG: And how have the patients involved in the pilot projects been reacting?

McALLISTER: Well, in the first few days of our seniors Drug Profile pilot in an Edmonton hospital, for example, we had 98 people come in to the emergency department that were in the right age group. As part of their sign-in process, the patients were asked if we could access their medication history. Ninety-seven of them agreed. As a result of their consent, their full medication history was available to and considered by their caregivers as part of their treatment. The only person who said no, said so only because it wasn't necessary. She had brought with her the full list of medications she was on. So we think people are responding well.

TIG: What can you tell us generally about the technology underlying your projects and the alberta wellnet?Are you building up your own database or simply connecting to other sources of information?

McALLISTER: I think the first thing that's important to understand is that we are a health information network-- and the approach we are taking is to safely and appropriately connect information that is already available from the stakeholders. That's the technical concept.

We are providing tools that allow health-care providers, physicians for instance, to collect or assemble appropriate information about patients from various sources across the health system. Again, they do this with the consent of the patients.

TIG: Is that cautious approach borne largely out of concerns over privacy and security or is it simply a better way to build a system?

McALLISTER: It's probably the most realistic way to build it, but it certainly addresses some of the privacy issues.

TIG: Can you also tell us something of the role of the private sector in establishing alberta wellnet?

McALLISTER: I think you're aware that we formed a strategic alliance with IBM Canada when we established wellnet. IBM brought together several other firms, all with an Alberta presence, and formed a consortium.

Within that consortium, we feel we have the capabilities to deal with the full range of systems integration needs. So, alberta wellnet is primarily private sector built.

Copyright Plesman Publications Ltd. Jul 1999
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