PAN-CANADIAN PUBLIC HEALTH COMMUNICABLE DISEASE SURVEILLANCE AND MANAGEMENT PROJECT

APPLICATION OVERVIEW PAN-CANADIAN PUBLIC HEALTH COMMUNICABLE DISEASE SURVEILLANCE AND MANAGEMENT PROJECT

Copyright Province of British Columbia All rights reserved Disclaimer All reasonable care has been taken by the Ministry of Health to achieve accuracy of this document, but we cannot guarantee the accuracy of this document s contents. By proceeding to the information beyond this notice, each reader waives and releases the Province of British Columbia to the full extent permitted by law from any and all claims related to the usage of material or information made available. In no event shall the Province of British Columbia be liable for any incidental or consequential damages resulting from the use of this material.

Table of Contents INTRODUCTION...1 BENEFITS...2 SYSTEM OVERVIEW...3 COMPONENT DESCRIPTIONS...5 COMMUNICABLE DISEASE CASE MANAGEMENT...5 OUTBREAK MANAGEMENT...8 IMMUNIZATION MANAGEMENT...10 MATERIALS/VACCINE INVENTORY MANAGEMENT...12 NOTIFICATIONS MANAGEMENT...14 WORK MANAGEMENT...15 SHARED SERVICES...17 ARCHITECTURE...20 TECHNOLOGY... 22 METHODS OF ACCESS...22 CONTEXT... 23 ROLES AND RESPONSIBILITIES... 24 JURISDICTIONAL IMPLEMENTATION LEADS...24 PRODUCT MANAGEMENT OFFICE...24 GOVERNANCE...24 PRIVACY SUMMARY... 26 FOR MORE INFORMATION... 27

Document Purpose This document is a management-level overview of Panorama, the health surveillance system currently being developed by the Pan-Canadian Public Health Communicable Disease Surveillance and Management Project. Panorama will be made available to all jurisdictions in Canada for implementation within their jurisdictional infrastructures. This document does not provide a precise specification of Panorama. It is a high level description of Panorama s capabilities. This second version of the document reflects the system design as of October 2007, and has been approved for distribution to all interested participants. Future versions will be issued as required to maintain currency.

Introduction The Naylor Report stated that Canada s ability to contain an outbreak is only as strong as the weakest jurisdiction in the chain of provincial and territorial public health systems and recommended Canada invest in a seamless public health system that will allow public health professionals to coordinate activities in a carefully planned infrastructure. This is essential if we are to be effective in managing public health emergencies. The Pan-Canadian Public Health Communicable Disease Surveillance and Management Project is responding to this recommendation by building a set of consistent, bilingual public health surveillance system components (Panorama) that will be available to all Canadian jurisdictions for implementation within their own health care information systems infrastructures. When implemented, Panorama will provide authorized health care professionals throughout Canada with the ability to collect, share and analyze a wide range of health information that is critical for managing health problems such as SARS and other communicable diseases at the regional, provincial / territorial and federal levels. As we know from SARS and influenza, the cost of not being prepared for an epidemic is in the billions of dollars to the health care system and to the economies of the regions affected. The Conference Board of Canada estimated that the SARS outbreak cut nearly $1 billion from Toronto's real Gross Domestic Product in 2003. The Government of Canada endowed Canada Health Infoway with $1.6 billion to foster and accelerate the development and adoption of electronic health information systems with compatible standards and communications technologies that provide tangible benefits to Canadians. A total of $135 million has been earmarked for public health surveillance. Infoway is funding 100% to develop Panorama and will also be covering up to 80% of the costs for Canadian jurisdictions to implement Panorama. The needs of Canadian public health professionals are driving the system design. Public health professionals have been closely involved in the project since the start, and continue to work to ensure the project team understands their requirements, and will deliver a system that will meet Canadian public health needs. Panorama will be available for use by all Canadian jurisdictions. This shared development strategy sets the framework for information sharing among health professionals to better serve the needs of Canadians. Once Panorama is in use, jurisdictions will continue to work together to support and enhance the system. 1

Benefits Panorama will provide public health professionals with the tools they need to better protect the health of Canadians Canadian public health professionals need efficient tools to assist them in effectively managing public health. Panorama will enable public health professionals to work together to efficiently manage individual cases, outbreaks, notifications, immunizations, and vaccine inventories across the country. Communicable diseases do not recognize geographic boundaries. Panorama will provide public health professionals with the tools to collect, share and analyze health information that is critical in managing public health outbreaks such as SARS, influenza and any other communicable disease as outbreaks move across regional and provincial / territorial boundaries within Canada, or emerge elsewhere and travel to Canada. Early outbreak detection and intervention are critical. Panorama will enable Canada to manage outbreaks through early detection, rapid verification and appropriate response to epidemic-prone and emerging disease threats. Panorama will help public health professionals reduce the spread of communicable diseases. It will allow for increased surveillance and better communication among Canadian public health professionals that will help them fight outbreaks. Provinces and territories will have access to the tools to respond appropriately to epidemic-prone and emerging disease threats and in turn, help to minimize their impact on people s health and on provincial and national economies. The health of Canadians will be better protected because we will be able to accurately measure vaccine coverage in our population. Public health professionals will be able to improve immunization delivery programs as a result, and support Canadian families in ensuring their members are appropriately immunized. The privacy of Canadians medical information will be protected. All information contained in Panorama will be protected in accordance with territorial, provincial and federal protection of privacy legislation. Panorama s security features will enable each jurisdiction to set it up to comply with their legislation. In the event of an epidemic, there is the possibility that a person s information could be shared between jurisdictions; however, this will only occur under clearly specified and legally binding conditions. The team developing Panorama will never have access to personal health information. 2

System Overview Panorama is a feature rich system that will help public health professionals across the country to work together to efficiently manage individual cases, outbreaks, immunizations, and vaccine inventories Panorama is organized as six major components that assist public health professionals conducting health surveillance. Communicable disease case management provides tools to help public health professionals identify and monitor cases, trace exposures and contacts and manage interventions, signs and symptoms and outcomes. Figure 1 Panorama Solution Components Outbreak management supports public health professionals who are investigating, monitoring, analyzing, communicating and reporting on outbreaks. 3

Immunization management enables public health professionals to forecast and record immunization information including information on consent and adverse reactions. Materials / vaccine inventory management allows public health professionals to record and maintain materials and supplies (vaccine and otherwise) inventories. Notifications management supports issuing warnings within Panorama and allows public health professionals to share information quickly about critical events and emergencies. Work management helps public health professionals to manage tasks and time at the individual, facility and organizational levels by providing scheduling, resource assignment, activity tracking and project management tools. Panorama is based on the privacy and security requirements of jurisdictional and national legislation and regulation centering on the provision of public health services to a client. One of Panorama s greatest strengths is that it is designed to integrate with the Electronic Health Record being developed in each jurisdiction. Plans are well underway to put appropriate governance, supporting organization and funding in place to ensure the long term sustainability of Panorama. The governing body will be comprised of all member jurisdictions and will manage product strategy, support and enhancement. 4

Component Descriptions Communicable Disease Case Management The purpose of communicable disease case management is to identify, investigate and manage cases, contacts and controls to reduce risk to the public s health from instances of communicable disease A communicable disease is defined as an illness due to a specific infectious agent or its toxic products that arises through transmission of that agent or its products from an infected person, animal, or reservoir to a susceptible host, either directly or indirectly through an intermediate plant or animal host, vector, or the inanimate environment. 1 Communicable Disease Case Management provides tools to help public health professionals: Record disease investigations and encounters for clients and non-human subjects (e.g. water samples, animals, food items); Manage information on case/contact disease classification, status, history, treatments, etc.; Investigate and track transmission/acquisition exposure events and trace contacts; Manage control measures, interventions and treatment plans; Monitor and analyze communicable diseases within defined populations; and Record communicable disease related prescriptions, drug therapies, adverse drug reactions and prescription history. Record Tuberculosis history and tuberculin skin test administration The Communicable Disease Case Management component includes the following general areas. 1 A Dictionary of Epidemiology, 4th ed JM Last (ed). International Epidemiological Association, Oxford University Press, 2001 5

Investigations The reporting source details, disease, classification, status, responsible organizational unit, etc. can be recorded and linked to related details such as risk factors, admission-discharge-transfer (ADT), treatment, assessment, provider, interventions, exposures, signs and symptoms and outcomes to document an investigation. In the course of the investigation, public health professionals can: Record signs and symptoms and the timing of those symptoms to determine the period of communicability. Create links within an investigation between details of contacts and cases to create exposures. (A contact describes details of a subject s exposure to a potential source of communicable disease. A case describes details of a subject s potential transmission of a communicable disease to another subject). Maintain an integrated record of all the information on a disease occurrence as the investigation progresses from contact to case. Group one or more exposure records to form an episode, and then apply clinical rules to determine if the episode meets the definition of a case, and may be considered part of an outbreak. Transfer investigation records between jurisdictions to ensure continuum of care. Record lab and diagnostic imaging test results, complications and outcomes for a subject. View a longitudinal history of public health interactions, listing a subject s investigation records and encounters. Record medical history, basic physical assessment details and travel data for a subject as part of the investigation process. Document a subject s history of allergies to ensure a treatment plan is appropriate and precautions are taken to ensure the health and well being of the subject. 6

Accept electronic laboratory test results as notification of communicable disease incidents and initiate investigation as appropriate. Monitor and analyze communicable diseases within a defined population and report notifiable conditions to the Public Health Agency of Canada (PHAC) to support Pan-Canadian epidemiological analysis. Classify investigations according to multiple case definitions, from local to provincial/territorial to federal. Support co-management of diseases that are present simultaneously Apply predefined algorithms to analyze disease incubation and communicability. Associate investigations to case control studies. Interventions An intervention is an action to resolve a public health issue or concern. Interventions may be medical (prescriptions, treatments, hospitalization), informational (education and counseling activities), regulatory (inspections, boil water advisories, food product recalls), or sanitation activities (facility cleansing) and can be recorded for both human and non-human subjects. Interventions may be delivered in person, remotely, or through various public media methods and may be for a specific time period or duration. Prescriptions Panorama supports creating prescription scripts, filling prescriptions, monitoring and reviewing drug therapies (e.g. periodic compliance tracking and Directly Observed Therapy for tuberculosis (DOT)), tracking and reviewing adverse drug reactions and viewing prescription history for a client. 7

Outbreak Management The purpose of outbreak management is to identify, investigate, manage and control an outbreak of a disease Outbreak Level Details An outbreak is defined as a rise in the incidence of a disease above what is expected for that time and place. Outbreak Management supports the needs of public health professionals investigating, monitoring, managing, analyzing, and reporting communicable disease outbreaks or public health emergencies, and includes the following features. Panorama provides the ability to identify all communicable diseases that are associated with an outbreak and link them together. Investigators can share information about common symptoms and signs to assist with identifying associated cases, and identify associations between outbreaks to link together a number of small outbreaks into larger, comprehensive outbreaks. Investigators are prompted to ask about specific signs and symptoms that have been applied to outbreak associated investigations and can record complications, such as Amputation, Neurological Sequelae and HUS at the outbreak level to help with outbreak analysis. Outbreak Subject Management Panorama provides tools to manage subjects within an outbreak. Users can view a tabular summary of the total number of subjects in an outbreak stratified by group and outbreak case classification; view a line list of associated subjects; view details in individual investigation records; rapidly enter subjects/investigations into an outbreak line list; upload investigation records into an outbreak that are associated with a named cohort; unlink investigations from an outbreak; and maintain outbreak case classifications. 8

Outbreak Communications Outbreak Notifications All communications associated with an outbreak can be tracked (i.e. notifications, notes, reservations/meetings, attached files, etc.) Panorama accepts and sends outbreak notifications across jurisdictions using HL7 messaging structures. Jurisdictions can share summary or detailed information to support multi-jurisdictional or border-crossing outbreaks. Outbreak Team Outbreak teams can be created by assigning members to a team. Team members are granted access to outbreak-related information and can receive notifications based on their role in the outbreak. Non-Panorama users can be granted access to outbreak teams and receive jurisdictional notifications. 9

Immunization Management The purpose of immunization management is to prevent or limit the spread of communicable disease by protecting individuals and populations through immunization An immunization is the technique used to cause an immune response resulting in resistance to a specific disease, especially an infectious disease. Panorama provides public health professionals with the tools to create and manage immunization schedules and accurately calculate eligibility; and plan, deliver and keep track of immunization sessions, including adverse reactions, precautions, contraindications, and exemptions. Users can view history for individuals and populations as well as lists of clients eligible or overdue for vaccinations by vaccine of interest, demographics and/or risk factors using the following tools. Individual Client Immunization For each individual client, Panorama can record the details of their administered immunizations and tuberculin skin tests, identify their susceptibility/immunity to disease(s), capture any special considerations, such as contraindications, exemptions and precautions and record consent or refusal to consent to immunizations. Panorama records administration at the agent and antigen level. Each additional immunization information or demographic data update triggers reevaluation of the client s forecast. Mass Immunizations Panorama provides the tools to help public health professionals plan, prepare and deliver mass immunization services such as school-based immunization programs by assessing immunization coverage for specific (cohort) groups, communicating and requesting updated immunization information. Public health professionals in the field can quickly update immunization data offline for later upload to Panorama. 10

Maintain Immunization Schedules Schedules for entire populations can be created based on National Advisory Committee on Immunization and jurisdictional guidelines, and Panorama can report on entire populations (immunization coverage) against the schedules to determine the success of immunization programs. Users can view individual client records to check their status against the schedules. For each client record, Panorama shows which immunizations are completed, due, eligible or overdue. Adverse Events Adverse events following immunization can be recorded and linked to specific immunization events. Those adverse events requiring assessment by the Medical Officer of Health can be automatically forwarded to obtain a recommended treatment and follow up. Events can also be automatically reported to the Public Health Agency of Canada to help with managing the safety of the vaccine supply in Canada. Compromised Vaccine Potentially compromised vaccines can be readily identified and marked for destruction, and removed from circulation. In addition, clients who have been vaccinated with compromised products can be identified and offered supplemental immunization. Reminder Recall Panorama supports the definition of groups of clients who are due, overdue and eligible for selected immunizing agents. The Reminder Recall allows targeted communication to the resulting client set, such as issuing reminders for overdue immunizations, advance notice of upcoming immunization dates, and requests for consent for immunization. In addition, in some jurisdictions, Reminder Recall provides an escalation of letters resulting in suspension from school if no immunization records are provided. When communication (e.g. letter, postcard) is sent to a client it is recorded against their client record for tracking purposes.. 11

Materials/Vaccine Inventory Management The purpose of materials/vaccine inventory management is to maintain appropriate levels of vaccine and other materials at locations where they are needed Materials/Vaccine Inventory Management is defined as the activities to plan, requisition and manage the supply of immunizing agents, medications, and other consumable materials. This component supports public health professionals delivering immunization and other public health services by providing tools to manage vaccine and supply inventory, track the vaccine cold chain, and support sharing or transfer of vaccine in cases of outbreak or shortage, and includes the following features. Define Inventory System A single configurable catalogue is used across each installation of Panorama. The catalogue includes lot records for products, order sets supported for each facility or customer, facilities and holding points in facilities. Panorama can maintain information on manufacturers and suppliers of catalogue products, and maintain profiles on each inventory holding point, such as facilities (refrigerated lockers/freezers etc.), replenishment source, delivery schedule, insurance coverage and maximum stock levels, etc. Maintain Inventory Levels Public health professionals can plan replenishment for each product at each holding point, and generate forecast demand quantities and forecast replenishment values for inventory items. Product can be ordered from suppliers; and weighted average cost of inventories can be automatically recalculated. 12

Requisition Product from Inventory Requisitions can be created for products to be distributed within a jurisdiction. Requisitions can be approved and inventory committed through an automatic process, or through a manual approval process at the replenishment source. Pick lists can be printed for selected products that have been requisitioned, and documents printed that are needed for shipping the products. The movement of an inventory item from one holding point location to another holding point location can be recorded. View Product Inventory A snap-shot of current product status within a facility holding point can be viewed, and product within each holding point counted. Users can make adjustments to stock quantities, reserve stock and account for losses/gains. Return Product Users can initiate the return of product within the distribution system (between all holding points recorded in Panorama), or from the jurisdictional depot back to an external supplier. Such returns may be caused by improper handling, manufacturer recall, or expiry. Contract Management Contract agreement details such as planning renewals, tracking products, maximum order quantities, credits and return policies recorded in jurisdictional contract management systems can be replicated in Panorama for reference purposes. 13

Notifications Management The purpose of notifications management is to ensure the appropriate dissemination of information to public health professionals There are three types of notifications in Panorama that support the communications needs of public health professionals: Jurisdictional Notifications; Threshold Notifications; and Client Warnings. Jurisdictional Notifications Jurisdictional notifications are unstructured messages that can be created and posted within a single instance of Panorama, then accessed by authorized users and emailed out to users external to Panorama. For the special case of notifications regarding outbreaks, Panorama supports the HL7 message transactions that allow jurisdictions to retrieve or send information on an outbreak to other Jurisdictions. Threshold Notifications Public health professionals can define rules for threshold notifications and review and approve notifications once generated due to the threshold being reached. Threshold notifications are messages to a specific user or group of users that are triggered when a particular set of rules (e.g. inventory, number of cases, etc.) are met. Client Warnings Panorama can establish and manage client warnings. Client warnings are client-specific, manually entered comments of any information that should be considered by a public health professional working with a client (e.g. drug allergies or potential client site visit risks such as aggressive dogs ). 14

Work Management The purpose of work management is to support managing time and tasks at the individual, organizational, facility, and role levels Work Management helps to ensure the quality and effectiveness of the business processes for communicable disease, outbreak and immunization management by enabling users to electronically manage the allocation of work, monitor the status of work items and report on work loads and volumes. Panorama provides a robust appointment setting and workload distribution system, and reports on resource usage and work activities by providing the following tools. Wait Lists and Follow-ups Wait lists can be created identifying which clients are waiting for an appointment, assigning priority levels, and creating reservations when a timeslot becomes available.. Panorama also maintains queues that are linked to scheduled reservations. Details of client follow-ups can also be recorded. Client follow-ups can be created, indicating that a client has been reminded of an upcoming appointment (e.g. phone call) and/or an email reminder to the client can be initiated. Reservations Reservations can be recorded and modified in Panorama using different views (day, month, year, free timeslots). Unique series of reservations can be created; for example, a client can be scheduled for a tuberculin skin test, a reading 48 hours later, a radiology appointment, and an appointment with a physician one week later. 15

Schedules and Workloads Timeslots can be managed according to a user s availability (e.g., vacation) or according to an organization s schedule (e.g. clinic days). Public health workers can also be assigned to support the activities of an event and the coverage for that event reviewed. Tasks and appointments can be balanced for individual users and users within a group. Highly urgent tasks, completed tasks and unassigned tasks can be reviewed. Throughout Panorama, events trigger the assignment of tasks so that work is queued appropriately. For example, the initiation of a new investigation triggers the establishment of a task on the primary investigator s work list.. Communication Event Logging Users can keep track of incoming and outgoing communications using a communication log. This function is useful for contract tracing, outbreak situations and for fulfilling medical legal requirements. 16

Shared Services The shared services component contains functions that support the other components of Panorama Supporting Functions Shared services functions include tools to manage demographic client information, code tables, reporting etc., as well as a number of functions which operate behind the scenes and provide Panorama s structure and rules, for example consent management, system auditing and provider maintenance, among others. It also includes functions that support Panorama in communication using HL7 messaging to labs, pharmacies, registries and hospital ADT systems. Access to Panorama is controlled through role based security which can be configured to meet the needs of each jurisdiction. Panorama has a 'break the glass' feature that allows security to be overridden in an emergency situation as well as comprehensive audit reporting of all unauthorized access. User Defined Forms User defined forms make it easy for users to enter information into Panorama by providing a way to customize Panorama to meet jurisdictional/program/situational (e.g. outbreak) needs. If new information needs to be gathered (e.g., a survey), a system administrator user can create a new form to capture it. Information gathered using a form gets entered into Panorama consistently resulting in high quality data for reporting purposes. User defined forms can be used when connected to the network, or off-line in the field. Document Management This service allows users to add, update, delete, and search for electronic attachments. Documents may be associated with a particular Client, Investigation, Encounter, Outbreak or action within the system, or may be items that are shared within a workgroup. 17

Notes Panorama supports nursing guidelines by enabling users to record narrative notes generally describing clinical information on subject, encounter, case, provider, supplier, product, and inventory transaction records that are accessible from every functional area of the system. Research & Reporting Workflow Panorama provides robust and flexible research and reporting tools to support public health professionals, epidemiologists and researchers in managing communicable disease investigations and outbreaks. Panorama can report on entire populations or specific groups in the population (cohorts), helping public health professionals to plan and deliver services. Over 150 reports have been designed to meet public health needs, and as well, users can create custom reports. Users can extract and transfer outbreak, case, immunization, inventory and work management data to external systems as well as to the Public Health Agency of Canada (PHAC). Data extracts are selectable by various criteria, and can be organized for input to jurisdictional data analysis environments. When Panorama is implemented with accompanying Geographic Information Systems (GIS) software, it can generate maps that display geo-referenced subject/cohort data (for reportable conditions, immunization coverage, etc.) Panorama can receive electronic Admission-Discharge-Transfer (ADT) messages from acute care facilities or record the information manually. These records are important to facilitate communicable disease control coordination between public health and the acute care environment. Workflows can be defined by system administrators, by creating a sequence of steps that can be used to guide a user through a specific task/job. 18

Lab Human and non-human lab tests and human diagnostic imaging tests can be requisitioned, results can be captured manually or electronically via messaging in Panorama. Cohorts A cohort is a group of subjects defined by a common set of characteristics. Cohorts are used throughout Panorama for mass immunizations, case management, outbreak management, studies etc. Bulk data updates can also be applied to a named cohort (e.g. setting the investigation status to closed for all subjects in the selected cohort). Human and Non Human Subjects Panorama is a client centric system. Users can enter a wide variety of demographic information about new or existing client/non-human subjects such as immigration and First Nation details. Once a record is added successfully, Panorama can send an update message to a jurisdictional registry or client index. Panorama s ability to accommodate non-human subjects (e.g. animal, fomite, water, vector, food) is key to describing exposures, product recalls, tracing contacts etc. Upload Panorama supports the ability to upload batches of data from external sources, such as school class lists. To preserve data integrity, the ability to upload and create records is limited to specific data elements that can be validated according to Panorama s business rules. This data includes demographic elements and immunization, investigation, and outbreak specific data as well as catalogue item numbers and inventory counts. 19

Architecture Panorama s business and infrastructure functions operate as services that deliver functionality to either user applications or other services. A highly simplified view is provided below. Figure 2 Panorama High Level Architecture 20

Canadian jurisdictions will determine how to install the Panorama components into their infrastructures. As a result of extensive consultation with public health experts, Panorama has been developed as a highly integrated product with some clear dependencies among the components: Outbreak Management is heavily dependent on Communicable Disease Management. Immunization Management is dependent on Materials/Vaccine Inventory Management. Communicable Disease Management is somewhat dependent on Materials/Vaccine Inventory Management. Work Management and Notifications Management have effectively become shared services that are used by the other components. As a result of these dependencies it is best to think of Panorama as consisting of two major function areas with associated supporting functions: Communicable disease investigation/outbreak management; and Immunization management; On a technical level, the system design allows jurisdictions to substitute other components, with the exception of the Communicable Disease/Outbreak pair. However, it is important to stress that this substitution will likely require the jurisdictional application to include new functionality in order to meet its public health business requirements. 21

Technology To support jurisdictional preferences, Panorama is designed to be installed into a variety of technology environments. It can operate on different brands of hardware, using any one of four common operating systems (AIX, HPUX, Solaris, or Windows). HL7 (a health system messaging standard) will enable instances of Panorama to exchange information with each other, and other health systems. For the Panorama user, desktop system cost and complexity is kept to a minimum. Panorama requires only a current computer running a web browser, such as Internet Explorer, and a wide area network connection to Panorama. Access is provided with secure access technology, and like any web application, Panorama is capable of running over low-bandwidth lines (e.g., phone lines) with some performance limitations. During system design, the public health experts placed heavy emphasis on ease-of-use features which will impact response times. Panorama's low-bandwidth performance characteristics are not yet known but will be measured during testing. Methods of Access There are two ways to interact with Panorama; via a web browser and via HL7 v3 messages Web Browser Messages Panorama provides a secure web-based user interface. Panorama will use HL 7 V3 to communicate with external systems, such as regional immunization systems, prescription drug registries and other provincial applications (e.g. inspections systems). Panorama can also exchange information with clinical applications, including physician or hospital electronic medical records, private and provincial laboratories, etc. Within Panorama, the services communicate with each other using a variety of interface techniques. The internal interfaces are made available to external jurisdictional applications for integration purposes. Panorama integration with existing jurisdictional applications that communicate using proprietary protocols, as well as those that use HL7 version 2.x will be a jurisdictional implementation responsibility. 22

Context Figure 3 - Context Diagram This context diagram depicts the business environment within which a typical instance of Panorama operates. The context depicted here varies in each jurisdiction that implements Panorama. A Panorama instance is populated, managed and accessed by a variety of participants using various methods and tools to submit, access and receive data. Participants can choose to use available Panorama web based functionality and/or to develop and implement electronic interface capability, depending on their business needs and preferences. 23

Roles and Responsibilities Jurisdictional Implementation Leads Each jurisdiction is responsible for its own planning, implementation and operation of its copy of Panorama to meet its specific needs. Each jurisdiction will establish an administration and management structure appropriate to its situation. Each jurisdiction has identified a Jurisdictional Implementation Lead to manage interactions with the Pan-Canadian project team during the development and testing phases of the project. Product Management Office In the future, the Panorama Product Management Office will provide a single focal point for cross-jurisdictional problem, change and release management activities. Governance A Product Management Board (PMB) will be developed to oversee Panorama maintenance and operations. The diagram on the next page illustrates the organizational structure envisioned to manage Panorama and its supporting structure. The PMB has overall responsibility for the long-term viability of Panorama. It has final decision-making authority for Panorama functionality and operations. It will oversee the long-term evolution of the core Panorama product, as it is enhanced and as its integration with jurisdictional systems becomes more complex. Through the PMB, participating jurisdictions will make their priorities and constraints known, and participate in the orderly process of both incrementally improving Panorama and allocating the available enhancement resources. Participation on the Product Management Board is necessary for a jurisdiction to accept and implement Panorama. 24

Figure 4 Governance Structure 25

Privacy Summary Privacy Impact Assessments Each jurisdiction will complete a privacy assessment as prescribed by its own applicable privacy legislation as part of their jurisdictional implementations. Panorama Privacy Risk Assessment A Privacy Risk Assessment (PRA) was completed to confirm that Panorama is capable of supporting compliance with jurisdictional privacy requirements so jurisdictional data custodians can protect personal information relating to communicable disease and immunization data while realizing the public good of increased public health safety. The objectives of the PRA were to: 1. Summarize work to date to privacy risk assessment and mitigation. 2. Report on the privacy risk assessment and mitigation approach of the project. 3. Identify privacy issues related to Panorama and their mitigation. 4. Ensure stakeholders are assured that privacy principles are addressed. 5. Lay the groundwork for future privacy risk assessments of Panorama including jurisdictional privacy impact assessments as part of jurisdictional implementation projects. The PRA discusses privacy risk management planning and work to date on the project. It incorporates a standard privacy assessment framework and focuses on the capability of Panorama to allow users to comply with jurisdictional privacy and security requirements and standards. The PRA was distributed to jurisdictional implementation leads. 26

For More Information For more information, please contact your Pan-Canadian Public Health Communicable Disease Surveillance and Management Project steering committee representative or visit the Panorama web site at http://www.epanorama.ca. 27

REVIEWS AND DOCUMENT CONTROL REVIEWS This document has been sent to the following listed below for their review and comment. Name Project Coordinator Team Integration Working Group, Jurisdictional Implementation Leads Project Executive Position Project Manager, Business Lead, Technical Lead, Communications Lead, Executive Team All members All members DOCUMENT CONTROL [Drafts start at 0.1 whereas a document ready for signature becomes version 1.0] Date Author Version Change Reference Oct 17, 2006 E. Solomon 0.1 Original document Nov 27, 2006 D. Button 0.3 Six components sections updated and revised. January 11, 2007 J. Harding 0.4 Completed all other sections, formatted and prepared first draft for review. February 1, 2007 J. Harding 0.5 Responded to review comments, redesigned document, rewrote most sections. February 6, 2007 J. Harding 0.6 Incorporated review changes. February 7, 2007 J. Harding, D. Cowperthwaite 0.7 Final review changes, ready for wider review (IWG, JI Leads). February 16, 2007 J. Harding, D. Cowperthwaite 0.8 Review changes from IWG, JI Leads. Draft for final executive review. February 19, 2007 J. Harding 1.0 For final review. October 24, 2007 J. Blue, D. 2.0 Updated to incorporate contract changes. 28

Date Author Version Change Reference Miller, A. Premji-Osman, D. Cowperthwaite, J. Harding 29