Speaking recently at a military health forum in Ottawa, Rear-Admiral Andy Smith described the Canadian Forces Health Information System (CFHIS) as “world-class” and “unrivalled in Canada.” When military medical personnel login, “they can see everything in Gagetown that was diagnosed in Wainwright,” the Chief of Military Personnel said. “It is an amazing system.”
Formally initiated as a project in 2002, the CFHIS has grown to be operational at almost 40 locations across Canada, as well as two bases in Europe and three locations supporting Afghanistan, and it is designed to be fully functional on Royal Canadian Navy ships. The system schedules appointments, integrates laboratory and x-ray applications, and more than a million documents have been scanned into the medical charts, giving medical personnel instant access to patient information anywhere in the world.
For any customer, public or private, large-scale information technology projects are notoriously risky. According to Tom Digan, president and general manager of Lockheed Martin Canada and the CFHIS contractor, National Defence adopted a phased approach to mitigate some of those risks. “They tried to make sure they could implement small sections and get user acceptance before they moved on to the next one. We got to learn what worked and what didn’t work.”
There are few more demanding IT customers than the medical or military communities. Between them, they demand high reliability, ubiquitous availability, rigid security and privacy, and for medical care providers, a high degree of user-friendliness. They simply will not tolerate anything that slows them down.
“The key to this was, it wasn’t going to be successful if users didn’t want to use it in the medical community of the forces,” Digan explained, “and a piece of that, as we went along, we actually had to take out because they liked a legacy system they were using as a stand-alone.” That piece will probably become unsupportable and DND will have to reconsider bringing it under CFHIS, but “you win their hearts over slowly and pretty soon you realize it’s time-saving, it’s better, it’s easier. Trying to convince some of your curmudgeons, so to speak, doctors and people who have always done it a different way to shift their way of doing business is also a challenge.”
As the program was implemented, health care practitioners maintained the old paper system, running in parallel with CFHIS. “Fear of the unknown will keep you running two systems, and they planned to do that for about five years, but after a year, they said, ‘why are we doing this?’ So they managed to get a big savings from tearing up the paper,” Digan recalled.
From a security perspective, “you would think you were dealing with a highly classified system, there are so many controls on it,” he said. However, as a defence contractor, Lockheed Martin Canada was already dealing with IT in environments that serve users with multiple levels of security classifications.
Battle tested
Despite Canadian combat engagements in Afghanistan and Libya, the workload for CFHIS has not increased. “It probably sped up the deployment of what they call deployed operations, to be used on ships and field hospitals, so they followed quicker than they normally would have,” Digan said, “but other than that, there was no big change.” He noted that the system was deliberately designed to have enough computer power to handle large, fast spikes in user demand, with a high peak capacity. “Over time, it has approached that, but we have never had a peak demand load that crashed the system.”
In recent months, the mental health of military members has become a greater concern. While CFHIS has limited functionality in that field now, it is capable of being extended to a full mental health capability. “On the mental health side,…my guess is that this is on the docket for the future. We don’t have a contract for that now but we are in discussions,” Digan said.
Canadian Forces members are a unique medical population, passing physical and mental hurdles to join, undergoing a huge variety of working conditions while serving, and now, carrying complete electronic health documentation for every moment of their careers and beyond. With some additional functionality and appropriate privacy safeguards, CFHIS could become a significant source of data for health care researchers in the future.