Future Initiatives

COMPETE III is one of few comprehensive electronic decision support initiatives in Canada targeting chronic diseases. Chronic diseases form the largest burden of illness in most developed countries.

Alberta has developed a regional approach, with chronic disease management being handled by the Regional Health Authority. Calgary and Capital Health Authorities have invested in regional portals that integrate data from various sources. The portals are the mechanism through which patients with chronic disease are identified and managed. Alberta has focused on disease specific minimum datasets. Physician involvement has been minor to date.

British Columbia (BC) has developed a physician-centric model, which has motivated some physicians to participate and to actively lead chronic disease management in the province. This model has been deemed successful and is being rolled out across the province. BC has also developed an HL7-standardized electronic medical summary (eMS), partly based on COMPETE II’s core dataset, and is working with several EMR vendors to extract data into eMS.

Ontario has approved 150 Family Health Teams (FHTs), the latest iteration of primary care renewal in the province. It is expected that these teams will be operational by 2007/2008 and will improve access to primary care for more than 2.5 million Ontarians in 112 communities. The teams include an interdisciplinary team of physicians and other providers such as nurse practitioners, nurses, social workers and dieticians all working together to see more patients and to keep them healthy. The Ontario version of a core dataset is still evolving.

COMPETE has been developing standardized technical and clinical architectures for some time. These are necessary to allow for high quality clinical decision support as well as the technical integration of data that makes decision support sufficiently sophisticated to be useful. As well, standardization of architectures is expected to allow for future economies of scale to allow expansion and sustainability. Our latest iteration of technical and clinical integration was tested in COMPETE III, a randomized controlled trial (RCT) with > 50 physicians and 1000 patients. For trial results see COMPETE III: A Chronic Disease Management Program for Diabetes and Vascular Disease and COMPETE III: Integration, Implementation, Innovation for Better Vascular Outcomes in [COMPETE Publications]

Clearly, there are several initiatives across Canada, each with their own approach, philosophy and style. Although we are still in the design phase of this market and merging projects for a pan-Canadian approach may be premature, there are opportunities to work together to deliver standard components that are required by all clinical IT initiatives in Canada, regardless of approach, philosophy or style.

As we move forward to COMPETE IV, we invite others who are involved in electronic clinical decision support systems to work with us to develop a world-class infrastructure for chronic disease healthcare in Canada.

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