Health IT Standards in Canada

In Canada, health IT standards are established by Canada Health Infoway's Standard Collaborative. Canada Health Infoway is a not-for-profit organization funded by the federal government to develop pan-Canadian health IT standards and provide incentives for the adoption of health information technologies.

HIT Standards

The following are key standards approved by the Standard Collaborative:

• Systematized Nomenclature of Medicine Clinical Terms (SNOMED CT) for problem lists, procedures, and other clinical observations. 35,000 SNOMED CT concepts have been translated to Canadian French
  
  
• HL7 Version 3 (HL7 V3) for clinical, financial, and administrative messaging and document exchange. Canada played a key role in the development of the HL7 v3 modeling methodology and tooling. The pan-Canadian HL7 v3 is used for the following core areas:
  
  
  
  • Laboratory
    
  • Immunization
    
  • Pharmacy (Drugs)
    
  • Client Registry (patient demographics)
    
  • Provider Registry
    
  • Shared Health Records
    
  • Electronic Claims
    
  • Public health surveillance
    
  
  
  
• HL7 Clinical Document Architecture (CDA) standards enables pan-Canadian EHR interoperability
  
  
• The pan-Canadian LOINC Observation Code Database (pCLOCD) for lab test results is used by the Lab Messaging and Nomenclature and Public Health Surveillance standards. PCLOCD adds and excludes certain records from the original LOINC standard to support Canadian requirements. Unified Code for Units of Measure (UCUM) is used for units of measures
  
  
• Diagnostic Imaging (DI) Standards are based on DICOM and IHE XDS-I
  
  
• The Health Canada Drug Product Database (HCDPD) provides coding for medications.
  

Certification

Infoway offers certification for the following classes of HIT software:

• Client registry
  
• Consumer health application
  
• Consumer health platform
  
• Diagnostic Imaging (DI)
  
• Drug Information System (DIS)
  
• Immunization registry
  
• Provider registry
  

The assessment criteria cover functionality, privacy, security, interoperability and management and are based on the following standards:

• Functionality – Canada Health Infoway Electronic Health Record Privacy and Security Requirements.
  
  
• Privacy – Canada Health Infoway Electronic Health Record Infostructure (EHRi) Privacy & Security Conceptual Architecture; Government of Canada’s Personal Information Protection and Electronic Documents Act (PIPEDA); The Canadian Standards Association’s Model Code for the Protection of Personal Information – CAN-CSA-Q830-03.
  
  
• Security – Canada Health Infoway Electronic Health Record Infostructure (EHRi) Privacy & Security Conceptual Architecture; The International Organization for Standardization’s Code of Practice for Information Security Management – ISO/IEC 17799:2005; The National Institute of Standards and Technology’s Recommended Security Controls for Federal Information Systems – NIST SP800-53;The USA Health Insurance Portability and Accountability Act (HIPAA) Security Rule.
  
  
• Interoperability – Canada Health Infoway pan-Canadian Standards and Conformance Profile Definitions for diagnostic imaging, laboratory, drug, shared health record, and demographic information.
  
  
• Management – The IT Governance Institute Control Objectives for Information and Related Technology (COBIT); The Office of Government Commerce’s Information Technology Infrastructure Library (ITIL).
  

Architecture

The following diagram from Infoway's web site depicts the high level architectural vision from an end user perspective (click to enlarge).




My Assessment

Overall, I am pleased with the choices that have been made by Infoway's Standard Collaborative. I believe that HL7 V3 is a step forward compared to HL7 v2.x because it is based on XML, it is more amenable to a Service-Oriented Architecture (SOA), and it defines a healthcare Reference Information Model (RIM) with associated modeling methodology and tooling. Beyond ICD-9 and CPT, SNOMED CT is definitively the medical terminology language of the future. Consistency is needed for units of measure for lab test results and UCUM is a good choice.

Some flexibility will be needed in standardizing transport protocols to allow lightweight solutions such as SMTP for point-to-point connections (what our friends in the US call NHIN Direct). The e-Health certification process should include some HIT usability testing (see my previous post on the experience of the British NHS in this area).

I am not aware of any pan-Canadian standard in the area of quality reporting. I would like to see Canada Health Infoway put more efforts into creating specifications (messaging, security, privacy) and open source tools for Health Information Exchanges (HIEs) at the provincial and federal levels. More work needs to be done in promoting the use of Computerized Physician Order Entry (CPOE) systems and Clinical Decision Support Systems (CDSS) for the automated execution of clinical guidelines. Finally, more guidance is needed in the area of patient consent in the context of electronic health information exchanges.