Two articles published in the Canadian Medical Association Journal (February 22, 2011) bring into question Canada’s national health IT strategies.
The first is a peer-reviewed article, “A qualitative study of Canada’s experience with the implementation of electronic health information technology”. Tamblyn, R., Bates D.W., et al. analyzes the 10-year history of Canada’s e-health plan. Through a series of structured interviews and reviews of national reports and documents, the study presents the following conclusions:
- Successes include the development of national standards, patient registries and the deployment of digital imaging.
- A number of deficiencies and barriers were also identified including the lack of national e-health policy, inadequate involvement of clinicians, failure to establish a business case for using electronic health records, a focus on national rather than regional interoperability, and inflexibility in approach to a dynamically changing environment.
Recommendations include the need to actively foster adoption through bottom-up, clinical-needs-first approaches and implementation of financial incentives based on patient outcomes that can be achieved with electronic health records.
The second article, “Medical data debates: Big is better? Small is beautiful?” Webster, P.C. takes a more critical look at the success rates of large centralized technology systems such as Canada Health Infoway’s model of the nationwide network of federated systems to enable the sharing of data in different jurisdictions. The author points out that the shared record model adopted by Canada Health Infoway has in large part been discredited and discarded in the UK. He notes that (Canada Health) “Infoway rejects the notion that a shared records model is a centralized behemoth that is somehow incompatible with, or antithetical to, sharing of patient information at the physician level.”
According to Webster, critics warn that Infoway has forged “Soviet-type” over-centralized approaches based on a top-down vision of a “federated set” of “health information data warehouses” with highly centralized access to “shared records”.
Another critic believes that Infoway’s blueprint, the technical plan by which the agency maps national interoperability, “is fundamentally wrong from a clinical perspective” because it puts the needs of patients and physicians last and that the focus should have been to start with primary care and add interoperability at a later stage.
What are your thoughts? Is Canada moving fast enough? Do we have the right approach? What can be done to accelerate adoption of EMRs?
Is this a topic you would like to see debated in an upcoming CanadianEMR Webinar?
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