Public health IT
Assessment of Panorama is released by
TORONTO – Canada Health Infoway has
released an independent evaluation of its pan-Canadian Public Health
Surveillance (PHS) system investment program – a project known as
Conducted by KPMG and made available in late March, the report concludes
that Infoway, in collaboration with its jurisdictional partners, is
meeting most of the objectives set for the $135 million project.
Panorama was due for completion in March, 2009, and the various
jurisdictional implementation projects are anticipated to be completed
between 2010 and 2012. One province, Alberta, has opted not to implement
According to the KPMG report, the areas in which Panorama meets the
needs set out for it are:
• High quality, timely surveillance data at the regional,
provincial/territorial and federal levels drawn from feeder systems that
support health delivery.
• Outbreak case, contact and quarantine management for infectious
diseases within regional and provincial/territorial levels.
• Maintenance of immunization records. However, in many jurisdictions
family physicians perform a large proportion of immunizations and the
availability of this data will depend on their adoption of the
Electronic Medical Record as part of the broader Electronic Health
Areas where Panorama’s capabilities differ from the needs set out for
• The ability to send and receive data from laboratories. Panorama will
be able to receive, but not send, data. The decision to exclude sending
of data was based on the limited ability of most public health systems
to receive orders via Panorama messaging.
• The ability to both send and receive data from hospital infection
control was excluded. This capability was of lower priority to
stakeholders and also reflected the extent to which data on possible
public health risks could be readily generated and transferred by the
various feeder systems used by hospital infection control functions.
• Outbreak management at the federal level. Further clarification of the
intended federal approach to pan-Canadian outbreak management by the
Public Health Agency of Canada (and development of related messaging),
and establishment of data sharing agreements is necessary before this
functionality can be implemented.
• Water quality and food inspections. Panorama has not been designed to
manage water quality and food inspections. However, data from lab tests
for water and food safety will be available.
It is anticipated that the PHS system will enable improvements in the
management of public health in Canada in four areas:
• Improving health outcomes related to the identification and management
of infectious diseases;
• Better infectious disease case, contact and quarantine management;
• Better identification, tracking and management of infectious disease
outbreaks and risks to health related to infectious diseases; and
• Research and analysis to support improved preparedness for future
infectious disease outbreaks and risks to health related to infectious
However, KPMG noted the Panorama PHS system is at a point where the
participating provinces and territories are engaged in planning for its
deployment or in the early stages of implementation, and as such, it is
too early to draw conclusions regarding the benefits of the system for
public health management in Canada.
Key informants who were involved in the development of Panorama and
Jurisdictional Implementation projects believe that the PHS system has
the potential to enable significant improvements in public health
management, particularly with regard to the first three impacts listed
above, on an intra-jurisdiction basis and potentially at
inter-jurisdictional and national levels.
Improvements in data compilation and sharing made possible by Panorama
are expected to enhance the availability of data for research and
analysis in support of planning for infectious disease outbreaks and
The ability of Panorama to achieve these outcomes depends not only on
its functional capabilities but also on a range of other critical
success factors that are largely outside the direct control of Infoway.
Key amongst these are building its acceptance among end-users,
clarification or establishment of business processes and data sharing
agreements for interjurisdictional data sharing and outbreak management,
further development of data feeder systems, and the establishment of a
governance and funding structure for Panorama’s longer term
The initial implementation strategy for the PHS program anticipated that
Panorama would be developed and available for jurisdictional
implementation approximately 12 months after the chosen vendor (IBM)
started work, consistent with an expectation in the Agreement that
development and implementation of the system would be achieved by the
end of 2008/09.
This ambitious timetable for Panorama’s development was not achieved due
to the complexity of the requirements and the discovery that an approach
primarily based on commercially available software was not feasible,
necessitating a much greater degree of custom design.
The combination of these two factors meant that the timeline was
ultimately extended by approximately 18 months and the scope of some
functions was narrowed compared to what was envisaged in the original
definition of requirements. In turn, this delay pushed out the start and
anticipated completion dates for provincial/territorial jurisdictional
KPMG’s analysis drew upon a program of key informant interviews with 25
stakeholder representatives (PHS Steering Committee members,
pan-Canadian and jurisdictional implementation project leads and
managers), six Infoway managers with management and oversight roles for
the PHS program, and a review of background documents relating to the
planning, management and delivery of the PHS program.
The report can be found at:
In March, 2004, the Government of Canada provided $100 million in
funding (increased to $135 million in 2007) to support the development
of a pan-Canadian Health Surveillance System. The Agreement defined this
system as being an electronic information system that supports the
collection, collation, analysis, interpretation and dissemination of
routinely collected health surveillance data through the integration of
business processes, standards, information and communications
technologies to guide public health action generally and to manage
infectious diseases specifically.
In developing the PHS system, Infoway was required to respect the
following set of parameters for the delivery and management of the
• Support the development and implementation of a pan-Canadian Health
Surveillance System, and adopt a pan-Canadian approach;
• Invest the funding provided in the development and implementation of
the solution, not ongoing operation and maintenance;
• To work in both official languages;
• As a general rule, at least 20 per cent of the development costs of
PHS projects or arrangements should be funded by the jurisdictions and
up to 80 percent by Infoway;
• Provide for integration with the EHR architecture and infostructure,
where appropriate; and
• Build on federal, provincial and territorial partnerships, avoid
duplication, realize economies and achieve interoperability.
Infoway allocated $59.9 million to the pan-Canadian solution work and
$75.1 million to support the various jurisdictional implementation
Infoway’s investment strategy for the PHS program provides for 100%
funding of the development of the pan-Canadian projects, such as, the
development of Panorama and underlying standards, 75% of the eligible
costs of provincial and territorial planning for implementation, and up
to 80% of the eligible costs of jurisdictional implementation projects.
Panorama is a set of applications and tools developed to satisfy the
expectations set for the PHS system. It is built around six functional
applications and seventeen supporting applications. The six functional
applications are designed to enable the management of communicable
disease cases, outbreaks, immunization programs, public health materials
and vaccines, notifications regarding critical events and emergencies,
and public health work tasks.
Panorama is a complex product, with approximately 3.5 million lines of
code, designed to support an equally complex set of public health
management functions throughout Canada.