Executive Summary



November 1998

The Newfoundland and Labrador Centre for Health Information (NLCHI) is seeking approval to move forward with the first two phases of the Health Information Network (HIN) for Newfoundland and Labrador. This report presents a Benefits Driven Business Case (BDBC) which supports the NLCHI vision to develop a health information network that will: improve the quality of health care in the province, through the provision of accurate and timely information to the appropriate care-delivery and decision-making stakeholders and to the public (NLCHI Information Systems Strategic Plan, KPMG, 1998, p.19).

Extensive stakeholder consultations identified a number of opportunities for improved health outcomes, local information technology (IT) industry development, economic benefits, and direct financial savings. While acknowledging the value of an HIN, stakeholders expressed concerns about a variety of issues they felt needed to be addressed, most notably related to privacy and confidentiality of personal information.

Health, economic, and financial benefits exist for a unique personal identifier, some elements of an electronic health record (i.e. medication and diagnostic service histories), online prescribing and test ordering, enhancements to the Client and Referral Management System (CRMS), and clinical decision support tools. Health benefits include reductions in adverse drug events (ADEs), earlier identification and monitoring of candidates for immunization, improved care through enhanced information access, and decision support for multidisciplinary teams. Economic benefits include a significant impact on Newfoundland and Labrador’s IT industry in terms of additional jobs, diversification of expertise, and an enhanced globally competitive position in the health informatics marketplace.

The incremental implementation approach to achieve the financial benefits reflects stakeholder input, maximizes the use of existing health care system technology, and acknowledges the financial realities of the province. The proposed conceptual technology architecture and supporting change management strategy are tailored to address both technical and stakeholder issues.

The implementation approach has eight phases:
  1. Unique Personal Identifier
  2. Personal Medication Dispensing History
  3. Personal Diagnostic Service History
  4. Diagnostic Service Requester Decision Support
  5. Personal Medication Regimen
  6. Personal Health Information Profile
  7. Physician Practice Pattern Profiling
  8. Clinician Decision Support Tools.
The eight phases are the components for a comprehensive HIN to be developed over five years and beyond. The business case recommends that only two be undertaken in the first year:
  • development of the Unique Personal Identifier for the province (UPI); and
  • development of the Personal Medication Dispensing History (PMDH).
The cost/benefit analysis, see Table 1, which was confirmed by Newfoundland and Labrador stakeholders, provides detailed information about the first two implementation phases. If the first five implementation phases (including the two recommended for Year One) go forward, then after a five-year period the associated total benefits, after costs, will have a net present value (NPV) of $3.6 million (see Appendix C). This estimate emerges from a "probable case" with total capturable benefits of $36.5 million, costs of $29.9 million, and a net saving of $6.6 million. Additional savings will accrue over time.

The challenge of the business case is to propose a plan to bring the vision of the full HIN to a reality, while recognizing the severe financial constraints facing the public sector. This means two things:
  • the business case must first focus on where the majority of resources in the health system are allocated; and
  • some compromises are necessary with respect to the Health System Information Task Force vision of a fully decentralized network.
The BDBC demonstrates that there are real, capturable, financial benefits to be obtained through the establishment of an HIN in the Province of Newfoundland and Labrador. In addition, there are benefits which cannot be directly captured as financial savings but will accrue to the provincial economy. Most importantly, there is an opportunity to improve the health and well-being of the people of the province through improved health information.

Download full document in PDF format.