Shifting into high gear

The Canadian healthcare system is enthusiastically embracing e-health, but widespread implementation of electronic health records (EHRs) is still several years away, according to a study by an Ottawa-based health consultancy.

The Branham Group, in its second annual e-Health in Canada survey, reported that a majority of Canadian hospitals have, at the very least, implemented basic administrative, financial and clinical applications and that most have plans to implement more advanced clinical and business systems.

Based on that data, Branham concluded that e-health has “crossed the chasm” from the early adopters to the mainstream market.

The data was gathered through two primary methods: extensive background research, including healthcare organizations’ business plans, annual reports and requests for proposals (RFPs), as well as about 150 interviews with industry leaders across Canada, said Michael Martineau, a director with the Branham Group.

“The respondent profile included contributions from people at the hospital level and the provincial level,” said Martineau. “There was a large contingency from Ontario because the province is just going through its regionalization process, so we had to get out to the individual hospitals.”

In other provinces, researchers talked to regional health authorities to get data on large numbers of organizations, he added. “We found that across the country in the hospital sector, for the most part, vendors in the hospital information space have already been selected,” said Martineau.

“This year, hospital CIOs are concentrating on implementing the functionality in the software they purchased. There has been a major shift from planning to implementation.”

Another trend observed by the study was consolidation driven by regional aggregation. In Newfoundland and Labrador, for example, they have recently reduced the number of regional health authorities.

“If you talk to e-health leaders across Ontario who are starting to put together their new e-health strategies, you will find that consolidation plays a big part there as well,” said Martineau. “The result will be fewer data centres and networks, and there are potentially going to be fewer vendors.”

As can be seen in other industries as they start to mature, the CIO wants to have only a few key players that they want to work with, and they’ll pick those vendors strategically, according to Martineau.

“It is a challenge for the vendor community to understand that they have to step up because CIOs are looking for enterprise partners that they can work with for the long term,” he said.

The study came to this conclusion after identifying approximately 300 vendors pitching into the Canadian healthcare community, either by advertising, showing up at industry trade shows, or by some other influence with the healthcare community.

Half of the vendors were Canadian-owned and half were private companies, with a 62 per cent majority being software vendors.

“Only about 12 per cent were infrastructure vendors,” Martineau said. “That is interesting because we are seeing infrastructure in other industries slow to mature as well.”

What advice does the study offer to vendors based on CIOs’ survey responses?

First and foremost, the one thing that came back most prominently was to implore vendors to understand the healthcare market, according to Martineau.

“Understand healthcare as a vertical, understand the Canadian market is distinct from the U.S. market, and they must understand that it is publicly funded,” he said. “You have a public procurement process in Canada, so end-of-quarter deals don’t really mean much to a CIO here.

“Finally, understand me as a customer. Not all healthcare organizations or companies are equal, because there are differences provincially and regionally.”

Other key findings from the Branham study include:

• A majority of the healthcare organizations interviewed by Branham permit the use of wireless devices in their facilities, at least by staff if not the general public, and are aggressively deploying wireless infrastructure to support planned point-of-care applications such as electronic clinical documentation.

• There is little interest in using open-source software, particularly for clinical applications.

• There is considerable interest in voice over IP (VoIP) and voice recognition technology, with nearly three quarters of the organizations interviewed indicating that they have implemented or plan to implement these technologies.

• Seventy-six per cent of those interviewed felt that Canada Health Infoway was having a positive impact on the Canadian e-health agenda, with 85 per cent supporting additional funding for Canada Health Infoway.

Brian Eaton is associate editor of and can be reached at