EHRs get a nod

Significant progress has been made in implementing electronic health records (EHR) across Canada, although competing priorities in health care suggest that it may not get the attention it deserves, according to Richard Alvarez, president and CEO of Canada Health Infoway.

But Alvarez believes a recent report by the Health Council of Canada (HCC) should keep the EHR debate top of mind.

Released in early February, the report – Health Care Renewal in Canada: Clearing the Road to Quality – says that to improve the health of the nation, Canadians need quality health care, not just faster health care.

The second annual HCC report tracks how well the federal government, the provinces and the territories have done in meeting the commitments they made to renew health care under the federally funded 2003 and 2004 health care agreements.

The report also recommends ways to strengthen the accountability, co-ordination and sustainability of Canada’s health care system.

“What we have been missing around the EHR debate is very high level support,” said Alvarez. “This is absolutely essential to health reform in Canada.”

The HCC is basically the watchdog of the premiers and the prime minister in terms of looking at how health care reform is progressing and what needs to be done to renew the health care system in Canada, he said. With the HCC coming out and saying EHRs are absolutely essential, the issue will get the attention it needs.

“Traditionally, information technology for many reasons hasn’t moved in the health industry at all,” Alvarez said. “In a lot of cases the actual technology itself, the actual software hasn’t been there.”

The issue around building software to accommodate an individual health record has never been there, he said.

“The technology that was developed in health care followed a business model,” Alvarez said, “and the old business model was around hospitals, doctor’s offices and community care centres, and each one of them had their own technology.”

The whole concept that health care is about the individual and records should follow individuals regardless of where they get health services is a relatively new one, he said. But while that is a big part of the problem, it isn’t the only one.

“We have never had that type of architecture in software before,” Alvarez said. “Coupled with that is a whole culture issue around learning and adoption. Many Canadian clinicians have been out of medical school for 20 or 30 years, and retraining them is clearly a slow process.”

Funding is a huge issue for the health care system generally and reforms like EHRs in particular, Alvarez said. Money has not been available because there have been no surplus budgets.

“We are delighted with the Council’s recommendations because the policy statement that came from high up said they were going to accelerate EHRs and the resources will be behind it,” Alvarez said.

The discussion about health care has focused overwhelmingly on wait times and access to care – as opposed to EHRs – according to HCC chair Michael Decter.

“Access is important, but it’s time to balance the discussion and devote equal attention to the quality of care Canadians receive,” Decter said.

The HCC believes there is no single route to a healthier Canada, but the electronic delivery of health services plays prominently in the report.

“We’ll get safer care when there is an EHR for all Canadians,” Decter said. “We’ll get more appropriate care when the right health care providers are available to the public in the right numbers at the right time in the right place.”

Additionally, Canadians will get better care when primary health care teams equipped with the right electronic tools offer effective chronic disease management and better health promotion, he said.

The HCC’s key recommendations include speeding up the development of EHRs, calling for EHRs for all Canadians by 2010 as well as electronic drug information systems.

Governments should make comprehensive, mandatory electronic drug information systems and e-prescribing a priority and integrate them into EHR implementation.

Finally, the report called for information systems that identify patients whose waits are becoming unusually long, triggering an audit, and establish an appeal process for patients who feel they’ve waited too long.

Infoway says it is on track to have EHRs available for 50 per cent of Canadians by the end of 2009. 068913

Brian Eaton ( is Editor of and a senior writer with CIO Government Review.

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