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I think that with Medicare being a federal matter in the US and provincial in Canada likely helps explain the lack of a national EMR program to set our standards. Unfortunately this has meant much waste in duplicting resources to come up with standards for each province. Considering there is national funding to encourage the provinces, you would think there would have been incentive to work together.

As for e-prescribing...what a missed opportunity to encourage adoption and penalize those not adopting EMR. In the US, after an initial incentive period, from what I understand, there are penalties if you don't e-Rx. This sounds like a good way to get more people on board with EMR.

Norman Yee

You're right, Al, it is policy. But let me cut right to the heart of it. In no jurisdiction in Canada, provincial or federal, have we had the necessary vision, support and incentive to reform our challenged healthcare system, and in particular, that of health IT. What we really need is a fundamental change (policy) that will value health information. If we value and remunerate the collection, collation, sharing, and primary/secondary use of such information, then we will see a substantial change in the demand and uptake of EMR and related e-tools. And, no one will need to fund any such tool. Clinicians will see value in the information they manage and go about acquiring the appropriate tools as an obvious cost of practice. (Strike "cost", make that "investment" since the return is built into the model of information remuneration; whether it is performance, outcomes or something else.)

Karim Keshavjee

Canada is a unique country when it comes to healthcare. We have socialized medicine, like most of the Western world, but we are situated near the world's largest market where even healthcare is a market.

This poses unique issues for us. Most of our innovations are imported from the US, not from other countries with socialized medicine. This generates great benefits for us because we can take advantage of the innovations that markets create, but it also generates friction because the cost of these innovations are high. However, the drivers for uptake of innovations is not the same for us as it is for the Americans. This creates friction in our health care system, preventing us from adopting innovations as fast as we'd like.

I recently presented on key policy issues Canada faces when implementing EMRs. I compared the policies of 3 provinces to 3 different EMR related policy frameworks: A) Creating an EMR friendly environment, B) Creating economic drivers for EMR uptake and C) Providing the services to encourage EMR uptake.

You can find the presentation at my LinkedIn profile below.

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