You would think that with almost 10 years of history promoting EMR adoption, Canada would be further ahead than we currently are. Why is this and what can be done accelerate adoption and use of EMRs?
I believe there are a number of contributing factors:
- Failure of policy.
- Inability to build consistent momentum amongst clinicians (Support and facilitation needs to be progressively ramped up. Every time programs or momentum slows, it becomes twice as difficult to engage clinicians the next time around.)
- Persistent gaps in the system (In particular, the ability to electronically prescribe medications)
- Failure to apply national coding and interoperability standards. (Without the ability to exchange information between systems and between providers, the value proposition for adoption of EMRs is just not high enough. The longer this is delayed, the higher the barriers to success.)
Of these four factors, the most important is 'Failure of policy'. There is a lack of national leadership in terms of direction setting, creation of programs to encourage the use of information technology and EMRs and creation of the overall environment within which technology supported care can flourish. It is simply not enough to create a single entity such as Canada Health Infoway, endow it with the responsibility to manage a single segment of the healthcare system (namely the EHR) and believe that the job is done.
With billions of dollars committed to encouraging the adoption and use of health IT and EMRs, I find it hard to understand why we do not have a role in Canada similar to the Office of the National Coordinator for Health IT in the US.
Can we be successful without strong clinical leadership and a national coordinator for Health IT in Canada? Perhaps, but this is not a sure thing and it is going to be very difficult to synchronize efforts across multiple provinces and get buy-in from physician organizations and groups across the country.
We are dropping the ball in Canada. No individual in a leadership position (in ministries of health at the provincial or national level or Canada Health Infoway) should be satisfied with the status quo. We should be admitting the existence of a serious problem, convening all stakeholders and developing a national strategy that enables us to move the health IT agenda forward.
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