May 6, 2011

Matthew W. Morgan MD, MSc, FRCP(C), FACP
Mount Sinai Hospital
Toronto, Ontario

Dear Matt,

Thank you for your letter highlighting the need for leadership on the use of the HIMSS EMR Adoption Model and the importance of a “controlled medical vocabulary”. With EMR and EHR adoption a priority for many of us working in health care today, your advocacy in the use of coded data to enable better care and answer questions on care delivery, care planning, population data analysis, and outcome reporting is very important.

The mandate of COACH includes ‘promoting the adoption, practice and profession of health informatics within the Canadian health system’ and to that end we are vitally interested in educating on the proper use of any adoption model. Particularly we are interested in making sure adoption models used in Canada fit to both the Canadian health care system and fit to the purposes for which we are using health information applications in this country.

We are also aware of the interests of the CIO community, through our CHIEF members and through regular interaction with those CIO’s. Their interests for comparability, relevancy, aligned definitions, objective use, and applicability are only somewhat satisfied by the HIMSS Analytics model. The primary use of the HIMSS Analytics model in Canada, I believe, is as a maturity model for assessing the degree to which hospitals have implemented software to support their clinical processes. The issue of consistency in application of the model is critical if we are to believe the results of the model.

I understand that HIMSS Analytics conducts interviews for hospitals at level 6 and onsite assessments for those at level 7. I do not know the status of the interviews for those three ‘level 6’ hospitals from the Globe and Mail article that you referenced in your letter. That would be a good question for the HIMSS Analytics organization.

In addition to the points you raised in your letter, COACH further recommends that Canada needs an adoption or maturity model that clearly fits with:

  • Our federated and regionally based health care system;
  • Our inclusiveness of primary, community and home care that are served by many health information and technology solutions (and the maturity of those solutions as part of an overall adoption);
  • Our definition of scope and interdependency between health care organizations (as related to regional centres, primary care networks, local health clinics, etc);
  • Our broader based “architecture’ of eHealth solutions (based on Canada Health Infoway’s model) that includes both technical and semantic interoperability;
  • The implementation of a commonly used controlled medical vocabulary for EMRs and EHRs together and related data collection goals; and
  • The most consistent, valid and reliable usage possible.

In the meanwhile, COACH does support the appropriate use of the HIMSS Analytics model as it helps to address hospitals and the comparability of their key EMR adoption components. We further support the efforts that HIMSS Analytics has begun to expand this model to ambulatory care settings and clinics.

COACH would be pleased to convene, with partners, a strategic session in this upcoming year on leveraging use of the HIMSS Analytics model and determining needs for a Canadian overarching adoption model or whatever is specifically beneficial. Measuring adoption is a well understood foundation for advancing EMR and EHR adoption, but one where Canada can improve, and in doing so ensure benefit to all patients, providers, delivery organizations, funders, and policy makers.

Matt, your promotion of this topic is valued and COACH would be pleased to co-author an article with you for our Journal to educate all our members on eHealth solution maturity models, the specific use of HIMSS EMR Adoption model and the fundamental requirement for “codifiable data.” Please let me know if you are interested in this and/or working with us on the strategic session.

COACH always welcomes such thoughtful letters and, on behalf of the Board of COACH, I want to thank you for raising this key issue.

Kind regards,
Lydia Lee, President, COACH: Canada’s Health Informatics Association

Cc: Richard Alvarez, President and CEO, Canada Health Infoway
Cc: John Wright President & CEO Canada. CIHI
Cc: Tom Closson President and CEO of the Ontario Hospital Association
Cc: Jeff Turnbull PRESIDENT Canadian Medical Association
Cc: Don Newsham, CEO, COACH: Canada’s Health Informatics Association