Health ReformALBERTA

IMPLEMENTATION TEAM

A L B E R T A

Health ReformImplementation TeamFinal ReportJ A N U A R Y 2 0 0 4

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I N S I D EFour Directions of Reform 4Achievement Highlights:

Patient/Customer Focus 5Sustainability 8Accountability 10Infrastructure 12

Final Analysis 14

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On January 23, 2002, the Alberta government accepted all44 recommendations of the Premier’s Advisory Council onHealth. The government plan, Alberta: Health First, Buildinga better public health care system, was developed to helpachieve these recommendations and chart a new course for

health care reform.

As part of the plan, the Alberta governmentappointed the Health Reform Implementation

Team: chair Dr. Larry Ohlhauser, health careconsultant, and team members economist Paul

Boothe and health services consultant Jeanette Pick.

The team monitored work on the government action planon health and provided progress reports to Albertans.

Team members supported the work of the MLA committeesand consulted with health care providers and regionalhealth authorities on how to overcome any barriers tobuilding a better public health system in Alberta.

This final report documents the many achievements thathave been made in the past two years and highlights workthat still lies ahead in improving the public health caresystem in Alberta.

Health ReformALBERTA

IMPLEMENTATION TEAM

1. Patient/Customer Focus– to help Albertans stay healthy and

provide quality service• New Canada Food Guide• 10-year health objectives and targets • Health information campaign• Non-financial incentives to stay healthy• Primary health care reform• 90-day access to services• Posting wait times on website• Centralized booking• Committee on Collaboration and

Innovation• Liaison with other ministries regarding

children completing education/trainingand financial assistance to supportchildren living in poverty

2. Sustainability: finances and people– to address health care funding,

expenditures and human resources• Containing drug costs• Integration of mental health services

with regional health authorities• MLA Task Force on Health Care Funding

and Revenue Generation• Expert Advisory Panel to Review Publicly

Funded Health Services

The 44 recommendations of the Premier’s Advisory Council onHealth have been consolidated under four main directions forhealth care reform. These four directions provide a solidfoundation for a public health care system that will serveAlbertans well into the future.

3. Accountability: policy, programs,delivery and evaluation– to encourage better health and

management of outcomes, and makethe best use of health providers• Alternate approaches to paying physicians • Comprehensive workforce plan • Health Service Utilization and Outcomes

Commission• Multi-year contracts between province

and regional health authorities• Health Professions Act Implementation

Task Force

4. Infrastructure support:information technology and management– to support the health system with

an emphasis on governmentcollaboration, information technology and research • Electronic Health Records• Long-term funding for information

technology• Province-wide standards for

information technology• Support research through a variety of

sources and organizations

Four directionsFour directions of reform

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Patient/Customer FocusPatient/Customer Focus: actions to help Albertans stay healthy and topromote quality in health services.1Achievement HighlightsPrimary health carePrimary health care is that all-important first point ofcontact a person has with the health system. Aprovincial strategy aims to improve access to primaryhealth care services.

Ten new primary health care initiatives are alreadyunderway, including:• A new primary health care centre in Strathcona

County• More health professionals and university

students are being placed in primary health caresites across the province

• A new program in Chinook and Calgary healthregions is assisting patients with chronic disease

• A new network in southern Alberta is improvingthe delivery of health services for children andyouth.

By 2004, up to 12 new local primary care initiativeswill be established to provide 24-hour access to acomprehensive range of health services.

Health LinkProvince-wide telephone access to 24-hour healthinformation has been completed. The new service isprojected to respond to more than 800,000 calls ayear.

As of June 2003, all Albertans can receive free healthadvice and information from a registered nurse 24 hours a day by calling Health Link Alberta toll freeat 1-866-408-LINK (5465). Health Link Alberta helpsAlbertans to receive an appropriate level of healthcare services and reduces thousands of unnecessaryvisits to emergency units. Health information is alsoprovided in up to 150 different languages throughinterpreters.

Health Link has expanded to serve Albertans withmental health concerns. Psychiatric registered nursesnow answer calls from people who need assistancewith mental health problems.

Access standardsAccess standards are being established as theacceptable period of time a person can wait fromwhen they are diagnosed to the time they receive the service.

Access standards for five key health services are beingestablished. Initial standards will be implemented byspring 2004.

A provincial working group composed ofrepresentatives from government, regional healthauthorities, physicians and other health careproviders are developing access standards for the fivehealth services: cardiac services, major jointreplacements, MRI/CT scans, breast and prostatecancer and children’s mental health services.

The Capital and Calgary Health Regions areconducting an impact analysis for access standardsfor cardiac services before standards will be appliedprovince-wide. Access standards for other serviceswill be implemented as part of regional healthauthority agreements in 2004/2005.

Wait list registryAn online wait list registry for insured surgeries andprocedures has been completed.

Albertans can now view waiting lists for publiclyfunded surgeries, MRIs, CT scans, radiation andchemotherapy through the Alberta Waitlist Registry.Patients and their physicians can access the websitefor accurate and current wait times across theprovince when discussing treatment options.

Included in the registry are wait times for hip or kneereplacements, cataract removal, and cardiac surgery.Information in the registry is submitted monthly byfacilities performing 200 or more procedures a year.All 38 facilities are expected to be online by spring2004.

More than 14,000 Albertans have visited the wait listregistry website since it was launched October 2003.

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Provincial Booking Services Program A centralized system to book select services willcomplement the wait list registry and electronichealth record system to improve access and choice forAlbertans.

Orthopedic procedures will be the first service to betested in the provincial booking services program in2004. Primary health care services will also be bookedthrough the Health Link information line beginningin 2004.

A complete centralized booking service is expected tobe available to Albertans by 2006.

Healthy targetsA plan to achieve a healthier population by 2012 hasbeen completed. The framework has establishedtargets in the following key areas:• reduce the rate of preventable chronic disease

including diabetes, chronic heart and lungdisease

• decrease the number of Albertans who are obeseand increase the rate of physical activity

• reduce the rate of substance abuse• lower the rate of preventable injuries.

The framework plan is being reviewed by regionalhealth authorities and will be incorporated intofuture regional health authority business plans. Onceapproved by government, implementation isexpected to begin later in 2004. Progress onprovincial targets will be primarily monitoredthrough data collected through the CanadianCommunity Health Survey.

Healthy U information campaignAn information program was launched in January2003 to encourage Albertans to lead healthy lifestylesto reduce their risk of chronic disease and obesity.

The three-year information campaign promoteshealthy eating and regular physical activity. HealthyU will help Albertans make healthy choices toprevent chronic diseases like cardiovascular disease,some types of cancer and Type 2 diabetes.

The Healthy U campaign has included a website, TVand radio ads, an insert for all Alberta newspapers, aschool calendar and promotion at summer festivalsand rodeos.

Tobacco reductionThe Alberta Tobacco Reduction Strategy was launchedMarch 2002 to encourage Albertans to reduce theiruse of tobacco. The strategy has included the highestone-day tobacco tax increase in the world of $2.25per 200 grams of tobacco, a toll-free Smoker’s Hotlineto help smokers quit, a province-wide publicawareness program and variety of education programto prevent tobacco use by youth.

The Alberta Tobacco Reduction Strategy has seen adramatic decrease in the number of Albertans whosmoke and a drop in tobacco sales since it waslaunched in March 2002. By 2002, the rate ofsmokers in Alberta aged 15 years and older droppedfrom 25 per cent to 23 per cent, the equivalent of44,000 fewer smokers. From 2001/2002 to 2002/2003,Alberta also saw a 24 per cent decrease in the sales ofcigarettes.

The rate of teenage smokers (15-19 years) has alsodecreased by 11,000 fewer smokers.

The Prevention of Youth Tobacco Use Act was proclaimedto make it illegal for anyone under the age of 18 touse or possess tobacco in a public place.

Patient/Customer Focus: actions to help Albertans stay healthyand to promote quality in health services.

Patient/Customer Focus

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IN IT IATIVE ACTIONS TAKEN STATUS AND NEXT STEPS

• Communicated need for revisedfood guide at September 2002 healthminister’s conference

• Research into use of guide has beenundertaken

New Canada Food Guide • Revised food guide will bedistributed once it has been finalizedby Health Canada

• Healthy U public informationcampaign and website launched.Campaign raised public awarenessfor healthy eating and physicalactivity

• Summer program launched

Health information campaign

• Incorporated into 10-Year HealthTargets Framework

Non-financial health incentives • Incentives to be featured as part ofHealthy U campaign

• Will be implemented as part of 10-Year Health Target action plan

• Ten primary health care projectsestablished

• Health link information lineexpanded province-wide

Primary health care reform • Up to 12 local primary health careinitiatives will be developed in 2004as part of the provincial primaryhealth care strategy

• Alberta will be the administrativelead in a provincial/territorialexpansion of health data trainingstandards

Access standards • Draft standards developed forcardiac services; provincial analysisto be conducted beforeimplementation

• Wait list registry for selectedprocedures posted

Alberta Wait List Registry • Standard data for all health facilitiesto be online by spring 2004

• Working group of government,regional health authorities andAlberta Medical Associationdeveloping requirements forProvincial Booking Services Program

Centralized booking (ProvincialBooking Services Program)

• Pilot of centralized booking ofcardiac services in Capital andCalgary Health regions in 2004/2005

• Implement province-wide bookingsystem for procedures, integratedwith hospitals and regional healthauthorities in 2006

• Report delivered to government; 49of 50 recommendations accepted

Committee on Collaboration andInnovation

• Multi-year performance agreementswith regional health authorities areexpected to be finalized in2004/2005 fiscal year

• Continued support for low-incomefamilies, early intervention andmentoring for children at risk

• Health Sustainability Initiativedeveloped recommendations toassist children living in povertyand provide educational support

Liaison with other ministries toimprove education and financialassistance to children living in poverty

• Access standards for five key healthservices developed: cardiac services,major joint replacements, MRI/CTscans, breast and prostate cancer andchildren’s mental health services

• Campaign will focus on low-incomegroups, workplace initiatives andcommunity challenge activities

• Benefits of immunization will benew focus of 2004

• Evaluation of campaign to becompleted

• Implementation to be undertakenby regional health authorities andother governmental departments

• Ten-year health targets andframework completed by cross-governmental committee

Ten-year health targets

Report of Expert Advisory Panel to Review Publicly Funded Health ServicesCurrent insured public services have been maintainedon the recommendation of the panel. The panel’srecommended process to assess what new healthservices should be covered by the public system wasaccepted in principle. The review process is beingdeveloped within existing department resources.

SustainabilitySustainability: actions to address how to pay forpublic health care in the long term.

Achievement HighlightsIntegration of mental health servicesRegional health authorities have assumedresponsibility for delivering mental health services toregional residents. A province-wide plan for mentalhealth services is being developed and expected to beimplemented in 2004.

Health care funding and revenue fundingThe MLA Task Force on Health Care Funding andRevenue Generation recommended options to pay forthe health care system; the report was delivered togovernment.

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IN IT IATIVE ACTIONS TAKEN STATUS AND NEXT STEPS

• Alberta uses results of national drugevaluation process to expeditereview of generic drugs and savecosts

Containing drug costs • Regional health authorities andAlberta Cancer Board buy drugs inbulk to reduce costs

• Alberta to co-operate in federal/provincial/territorial efforts to setnational best practices forprescription drugs

• Mental health services and fourmental health facilities transferredto regional health authorities inApril 2003

• Alberta Mental Health Boardmanages province-wide services forforensic psychiatry, suicideprevention, aboriginal mental healthand telemental health

Integration of mental health serviceswith regional health authorities

• New provincial plan for mentalhealth services is being completed;implementation expected in 2004

SustainabilitySustainability: actions to address how to pay forpublic health care in the long term.

• Task Force submitted report onrevenue generation and fundingoptions October 2002

MLA Task Force on Health CareFunding and Revenue Generation

• Report and recommendations beingreviewed by government

• Panel recommended process andcriteria for publicly funded servicesOctober 2002

• Panel reviewed options for alliedhealth services and recommendedbroad health categories to bepublicly funded December 2002

• Panel recommended criteria andprocess to review new publiclyfunded services March 2003

Expert Advisory Panel to ReviewPublicly Funded Health Services

• Government accepted panel’s reporton process and criteria for publiclyfunded services

• Government acceptedrecommendation to maintaincurrently funded insured publichealth services and rejected panelrecommendations to changefunding to allied health services

• Government accepted panel’sprocess to review new services and isimplementing a new review processwithin existing department means

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Accountability: actions to improve health outcomes andhealth system management.

New ways to pay physiciansNew payment methods are being developed to givephysicians more flexibility in how they providehealth services to Albertans. As of January 2004,approximately 430 physicians are involved inalternate compensation arrangements. Another 65 to70 initiatives are in development, which are expectedto involve close to 1,000 more physicians.

These alternate payment programs include physicianswho collaborate to provide primary health careservices; initiatives that provide specialized care forchronic diseases and mental health services andfunding plans that allow academic physicians moretime for research and teaching.

Alternative payment plans announced January 2004include:• A program to provide specialized care to patients

with severe headache disorders• A team of 44 family doctors, psychiatrists and

mental health practitioners to improve mentalhealth care for Calgarians

• A primary health care services centre to serveCalgary inner-city seniors

• Specialty clinics for cardiac care, hypertension,epilepsy, stroke, hepatitis and inflammatorybowel disorders serving patients in central andnorthern Alberta

By 2004, up to 12 new local primary health careinitiatives will be established to have physicians andother health care providers working together toprovide 24-hour access to a comprehensive range ofhealth services.

Comprehensive health workforce planA framework to recruit and retain the necessarysupply of health care workers to deliver healthservices has been completed. An action plan will bedeveloped in 2004 to have the optimal number, mixand distribution of health care personnel in theprovince.

Health Service Utilization andOutcomes CommitteeA survey, commissioned by the committee, foundthat most Albertans give good marks to the healthcare system. The survey showed Albertans wantimprovements to emergency services, access tospecialists, satisfaction in how complaints areaddressed and how patient safety issues are managed.

Achievement Highlights3Accountability

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IN IT IATIVE ACTIONS TAKEN STATUS AND NEXT STEPS

Alternate approaches to payingphysicians

• Comprehensive health workforceplan framework completed

Comprehensive workforce plan • Action plan to implementframework to be developed in 2004

• Commission issued first report cardand survey results on how Albertansview performance of their healthcare system

Health Services Utilization andOutcomes Commission

• Commission is reviewing patientsafety concerns, the patientcomplaint process andpharmaceutical prescribing patternsof family physicians

• Public Health Act regulationsamended to expand practice ofnurse practitioners

• Nine professions of 28 haveregulations under force of the HealthProfessions Act

• Delays to have more professionscome under force of the HealthProfessions Act has resulted fromprofessions requesting expandedscopes of practice

Health Professions ActImplementations Task Force

• Continued work will be done tocomplete regulations of allprofessions under the HealthProfessions Act

Accountability: actions to improve health outcomes andhealth system management.

Accountability

• As of January 2004, approximately430 physicians are involved inalternate compensationarrangements

• Another 65 to 70 initiatives are indevelopment to involve close to1,000 more physicians

• Development of local primaryhealth care initiatives in 2004 aspart of the Alberta MedicalAssociation agreement

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Infrastructure to Support the Health System4Electronic health record systemIn October, the provincial electronic health recordwas launched to provide secure electronic records ofpatient health information.

The first of its kind in Canada, the Alberta electronichealth record is a province-wide clinical healthinformation system that links physicians,pharmacists, hospitals, home care and other providersto a patient’s prescription history, allergies andlaboratory test results immediately online.

In December 2003, Drumheller became the firstcommunity in Canada to have all physicians, healthcare facilities and other health care providers use

electronic health records to provide health services tolocal residents.

By spring 2004, all Alberta health regions, one-thirdof physicians’ offices and half of all pharmacies areexpected to be using the electronic health recordsystem.

The electronic health record is a province-wideexpansion that follows successful pilot projects usingelectronic medication and laboratory information tomanage drug prescriptions and tests for thousands ofpatients.

Infrastructure: actions that support the health system, with anemphasis on information technology and research.

Achievement Highlights

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Infrastructure to Support the Health SystemInfrastructure: actions that support the health system, with anemphasis on information technology and research.

IN IT IATIVE ACTIONS TAKEN STATUS AND NEXT STEPS

• Pharmaceutical InformationNetwork pilot completed inWestlock and Leduc July 2003

• Electronic Health Record systemdeployed to regional healthauthorities August 2003

• Electronic Health Record expandedto physicians and pharmacistsOctober 2003

Electronic Health Records • All Alberta health regions, one-thirdof physicians’ offices and half of allpharmacies are expected to be usingelectronic health records by spring2004

• Investment funding strategy forinformation technology developed

Long-term funding for informationtechnology

• Investment funding strategy forinformation technology yet to beapproved

• Province-wide standards for healthdata established March 2002

Province-wide standards forinformation technology

• Data standards being developed forElectronic Health Record and healthprovider directory

• Work to increase collaborationbetween department and variousresearch partners

Support research through a variety ofsources and organizations

• Continued active involvement withthe Alberta Heritage Foundation forMedical Research, Institute forHealth Economics, Western CanadaWait List project and theintergovernmental Technology andResearch Advisory Committee

Drumheller hospital staff meet with Health Minister Gary Mar at launch of electronic health record system.

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Final AnalysisImplementing health reform is a complex processthat requires the necessary time to collaborate withall health care partners and determine the impact ofreform.

While delays have occurred with some initiatives –like the wait list registry and electronic health record– we are satisfied there has been steady progress onthe action plan on health.

However, we still await the completion of somemajor activities:

Primary health care reform: the new agreementbetween the Alberta government, the Alberta MedicalAssociation and Alberta's regional health authoritiesincludes a plan to expand primary health careservices throughout Alberta. Up to 12 local primarycare initiatives to provide 24-hour access to primaryhealth services are not expected to be underway untillater in 2004.

Multi-year performance agreements:agreements with regional health authorities to createnew efficiencies are being negotiated and areexpected to be part of the 2004/2005 fiscal year.These new agreements will be another vital part offinding new efficiencies and collaboration in publichealth care.

Centralized booking: a pilot project to testcentralized booking for orthopedic specialty services inthe Capital and Calgary Health Regions will occur in2004. Work is on schedule to provide centralizedbooking for select procedures on the ministry website by 2006.

Health Professions Act implementation: TheHealth Professions Act was passed in 1999 to set outcommon rules for Alberta's regulated health professions.Only nine out of 28 regulatory colleges have completedregulations under force of the Health Professions Act.

ConclusionIn this final report card, which marks the two-yearanniversary of the Premier's Advisory Council on Healthreport, we are confident the province has madesubstantial progress on its action plan to build a betterpublic health care system for Albertans. Major strideshave been made in the four directions of health reform:patient focus, sustainability, accountability andinfrastructure.

The achievements that have been made have put theprovince on a solid foundation to make the continualimprovements required for a public health care systemthat is efficient, affordable and of the highest qualitypossible.

Health ReformALBERTA

IMPLEMENTATION TEAM

For more information contact:

Alberta Health and Wellness

10025 – Jasper Avenue

Edmonton, Alberta

T5J 2N3

Phone: (780) 427-7164

310-4455 (toll free anywhere in Alberta)

www.health.gov.ab.ca

ISBN 0-7785-2688-7