E-health in Canada – 10 years and still waiting

eHealth Ontario may be the most notorious attempt at digitizing health records, but it certainly is not the only one. CARP recently met with a representative of Canada Health Infoway (CHI). Since 2001 CHI , a not-for-profit organization funded by the federal government, has been attempting to assist the provinces and territories in developing the infrastructure necessary for electronic health.

CHI was granted $2.1 billion in funding with the express mission of “fostering and accelerating the development and adoption of electronic health information systems with compatible standards and communications technologies on a pan-Canadians basis…” In an effort to make e-health a reality across Canada, CHI has a 75:25 cost sharing formula wherein the CHI pays 75% of the allocated costs and the provinces and territories pay 25%.

The $2.1 billion is targeted in 12 investment programs, including $52 million for architecture and standards, and $365 million for interoperable electronic health records, ranging from registries to diagnostic imaging. There is also $45 million allocated to consumer health solutions. Broadly speaking, CHI infrastructure is intended to cover three elements of e-health:

EHR – electronic health records – getting the laboratories, hospitals and other diagnostic entities sending digitized records to a central or shared repository.- which can then be accessed by doctors and other medical professionals, whether in hospital or family GPs

EMR – electronic medial records – doctor’s offices – digitized patient records – some interactivity with the HER

PHR – patient health records – access by patient to his/her own medical records from all sources – ranging from a passive digital copy of one’s own medical records – collected manually and then stored on some digital medium – to full patient portal access to the EMR and EHR.

By 2011, CHI aims for 50% of Canadians to have the necessary infrastructure in place to allow all three elements of e-health to move forward but readily admits that not much will be visible to the average patient. The money has not yet all been spent, and much of the progress, CHI claims, depends on take-up from the provinces, which is why Alberta may have more e-health infrastructure in place than does Ontario. As of March 2009, CHI reports reaching 17% of its 50% goal, meaning there is much to accomplish before 2011. It is not at all clear that Canadians will have the kind of direct patient access available in Europe and other jurisdictions any time soon. While there are certainly challenges in developing e-health across Canada and CHI is not alone in its endeavor to digitize health records, nine years and $2.1 billion dollars allocated is a long time for Canadians to wait for electronic health practices, especially as more Canadians are ready and waiting.

In a recent CARP poll , only 22% of respondents felt that medical records should not be online. Most [41%] wanted to access their online medical records along with their doctors and a further 30% were prepared to give access to their family and friends involved in their care. As a CARP media release noted, “the message to those tasked with developing and implementing the e-health initiatives across the country, is: ‘Get on with it!’ And to those still balking at the prospect: ‘Get moving or move aside!’”