Project: Regionally Accessible Secure Cardiac Health Records

Canada Health Infostructure Partnerships Program

Synopsis

Regionally Accessible Secure Cardiac Health Records (RASCHR) was put in place by the University of Ottawa Heart Institute (UOHI) to provide authorized healthcare workers in hospitals and clinics in Eastern Ontario immediate access to cardiac health records of patients who have had catheterization, percutaneous coronary intervention (PCI), or cardiac surgery at UOHI.

Using RASCHR, hospitals refer patients to the Heart Institute electronically, follow up to obtain booking dates for treatment and obtain results. For patients who consent, their patient record can be available to any of the participating hospitals in Eastern Ontario. Then, if a patient needs to visit a hospital, after treatment at the Heart Institute, their record is immediately available to the treating physician.

Rapid access to a patient's record is made possible by secure Internet connections to a database located at the Heart Institute. The security of the patient record is ensured through a public key infrastructure (PKI) system.

Outcomes

RASCHR clearly demonstrated that it is possible to build secure patient record systems that can be accessed over the Internet by a number of institutions in a region. Cardiac health records are now available to institutions that refer patients to UOHI. This facilitates the follow-up of a patient's treatment at UOHI by a regional hospital. It also makes the patient record available at many more locations should the patient have a reoccurrence of his/her problems and present at a hospital a later date.

RASCHR has built a solid foundation that can be expanded to collect more cardiac patient data electronically. Eventually RASCHR will be evolved to a full cardiac portal providing a range of cardiac information and services to both the healthcare providers and patients.

Lessons Learned

The lessons learned from the RASCHR project have been categorized into three sections:

• Adapting to change:
  
  
  • Start-up time for implementing a new information system within a hospital setting typically takes longer than planned.
  • Staff at participating hospitals need to have ongoing education and a well-defined mechanism for addressing concerns and issues with the use of RASCHR.
  • For future success of RASCHR, the Steering Committee needs to promote and facilitate demonstrations of the project to entice other institutions to join the program.
• Governance/Leadership:
  
  
  • Champions from referring hospitals are needed to promote RASCHR's capabilities and explore potential usage in other clinical arenas.
  • In development projects involving multiple sites, it is necessary to have a core group of individuals to manage the project and to communicate with their organizations on all aspects of the project.
• Infrastructure:
  
  
  • The implementation of the PKI security infrastructure was very labor intensive and needs careful management.

The Future

UOHI's longer-term view is an enhanced RASCHR system evolving to a cardiac portal providing a range of services to both healthcare providers and patients. Access to the cardiac health record would be expanded to include not only the clinics and hospitals that refer patients to UHOI but also family physicians, community care access centers and the e-Emergency system being put into place by Smart Systems for Health (SSH). In addition, services provided directly to patients would be included, such as: those recently discharged from University of Ottawa Heart Institute (UOHI) and those needing continuous monitoring as seen with congested heart failure patients.

Appendix A: Documents or Products Generated

Cardiac Health Information Portal Project Proposal Synopsis sent to Canada Health Infoway

RASCHR - Software Requirements Specifications

RASCHR - Software Requirements Traceability Matrix

RASCHR - System Design Description

RASCHR - Database Schema

RASCHR - Security Design

RASCHR - Acceptance Test Plan

RASCHR - Acceptance Test Procedures

RASCHR - Factory Acceptance Test Report

RASCHR - SAT Report

RASCHR - Training Plan

RASCHR - System Maintenance Guide

Online Patient Registry - Triage User Training (PPT)

Online Patient Registry - Clinician User Training (PPT)

RASCHR Installation Guide

Abbreviated Guide for the Operation on the RASCHR System

Draft Operational Policy

Security Assessment Post-Implementation

Security Assessment Pre-Implementation

Interface Specifications SMS Corporate ADT to RASCHR

Evaluation Pre-Implementation

Evaluation Final Report - Post-Implementation

Evaluation Design Methodology

Privacy Assessment Report by PRIVA-C

For more information, please contact:

Roy Marsh at marsh@ottawaheart.ca or at (613) 292-5927