- Smart Healthcare, Wednesday 23 September 2009 09.00 BST
A tall order: problems in Ontario introducing electronic health records are symptomatic of those across Canada. Photo of Toronto, Ontario: jiunlimited.com
So far, the Canadian government has piled over C$2bn (￡1.15bn) into the modernisation of its health care system, and is racing to meet a significant deadline for implementation next year. How is it doing?
As well as can be expected, according to some, who feel that its goals are nevertheless unrealistic. Canada Health InfoWay is the not for profit organisation formed in 2001 by the Canadian federal government to distribute funds and create guidelines for electronic medical records (EMRs). It wants to have an electronic medical record for every Canadian by 2015, and has also tasked itself with covering 50% of Canadians with EMRs by the end of next year.
"They are being overoptimistic with these projections," warns Norm Archer, professor emeritus in management science and information systems at McMaster University, who has conducted extensive research into the implementation of EMRs in Canada.
Health Infoway refused to discuss its progress, but the numbers in its latest annual report speak for themselves. At the end of March, eight years after the agency was formed, it revealed that it had only met 17% of its 2010 goal. That means it still has to cover two thirds of the 50% of Canadians that it wants to have an EMR by the end of next year.
"Provincially, the problem is getting EMRs into every family practitioner, and that has been an ongoing struggle," says David Wiljer, the founding chair of the Canadian Committee for Patient Accessible Electronic Health Records, who also directs a web portal project for chronic patients at Princess Margaret Hospital in Toronto.
Family doctors in Canada are largely private, and cannot be told what to do. They have to be convinced to move to EMRs. Michelle Greiver, a family physician in Toronto, has spent the past three years implementing and optimising her EMR system.
"My cost to start the EMR was approximately C$30,000, half for software and half for hardware," she says. However, there were additional costs such as an upgraded VPN router and a backup internet line, which she needed several times after the failure of lines provided by eHealth Ontario, the 700-person organisation with the job of modernising the Ontario health system.
"I think we will continue to see implementation failures, and the focus of support may need to change towards supporting those who have purchased, rather than encouraging purchases," she adds.
Health Infoway is obviously taking the family doctor issue on board. It has dedicated its C$500m allocation from the 2009 federal budget almost entirely to accelerating the implementation of EMR systems with such practitioners.
While the organisation battles to get family doctors on board, it is also hitting a moving target in terms of standards, warn experts. Until recently, the most commonly accepted standard for EMRs to support hospital workflows was Health Level 7 (HL7) version 2.
"Many institutions already use that to communicate with each other, but the problem is that it isn't really a standard," Archer says. "Institutions can use version 2 in quite different ways."
Health Infoway would like to migrate to HL7 version 3, says Archer, which supports any and all healthcare workflows using a more formal methodology, but it is a complex process. And that version was only ratified in 2005, four years after the organisation was formed.
But problems with eHealth Ontario are symptomatic of the fact that Canada Health Infoway isn't fully in charge of these projects. In Canada, healthcare falls under the jurisdiction of the country's 10 provinces. If and when the Canadian provinces are willing to modernise their health records, they form a partnership with Canada Health Infoway, procuring the funds for implementation, and hopefully following the guidelines competently.
"Ontario has done some things centrally, and they made some bad mistakes and wasted a huge amount of money," says Archer. The province recently fired the head of eHealth Ontario, after media attention over almost C$5m in no-bid contracts, and alleged overpayment of consultants. eHealth Ontario was only created in 2008, to replace the Smart Systems for Health Agency, which spent C$647m while failing to implement EMRs.
Faced with an army of sceptical private physicians, a depressed economy, a huge geographical area, and a problematic division of jurisdiction, Canada Health InfoWay certainly has its work cut out. It has just over 15 months to attempt to meet its first deadline, and in the meantime, an auditor general's report evaluating its progress will be published this autumn.
