Those who read this blog will be aware of previous articles I have written about the EMR market in Canada — most recently an update on provincial EMR funding programs in Canada. First, let me clearly state that provincial EMR programs have played a critical role in advancing adoption of EMRs in Canada. However, the programs are governed by provincial legislation and policies; as such, it is their mandate to operate successful provincial programs — not look out for the health of the EMR industry as a whole. And therein lies the conundrum.
A healthy Canadian EMR industry needs competition, innovation, revenue, and growth opportunities for vendors and the ability for EMR vendors to sell their products unhindered across Canada. This is particularly important for the smaller provinces that do not individually offer sufficient market opportunity for some vendors to sell their products without taking significant risk. This is further compounded by dual language requirements if a product needs to be available in both English and French. Current provincial strategies require EMR vendors to develop and maintain provincial versions of their EMR systems. Even if differences between provincial versions are small, vendors must still maintain multiple code sets in order to ensure the quality of their products in each market. The drivers are perfectly logical. Each province requires EMR systems that are designed to meet their needs under provincial mandates and policies. However as discussed above, what is good for a province is not necessarily good for an industry.
So, where does Crowdfunding come into the picture, and how is it applicable to the discussion on EMRs? A May 2, 2012, article in the Globe and Mail titled Crowdfunding: Why Canada is far behind the U.S. describes a situation eerily similar to the challenges faced by the EMR industry.
According to the article:
Crowdfunding relies on social media platforms to bring entrepreneurs and companies together, not unlike an online brokerage firm. Among the companies developing an internet-based exchange is Durham, North Carolina-based Motaavi. One of the company’s co-founders is Nick Bhargava, who is originally from Edmonton. He has no intention of setting up shop back home in Canada.
Mr. Bhargava and his associates spent months lobbying Congress to make crowdfunding legal. That was no easy thing, but at least they could focus their efforts on one government: federal securities law trumps state regulations.
In Canada, Mr. Bhargava would have to seek rule changes in each of the 13 provinces and territories. He reckons that’s more trouble than it’s worth.
Sound familiar? According to the author, what makes Canada unattractive to entrepeneurs like Mr. Bhargava is that he would need unencumbered access to the entire country to turn a profit.
The value of the central regulator cannot be underestimated. While this role has existed for acute care and large provincial health IT systems under the auspices of Canada Health Infoway, provinces have developed much more provincially focused strategies for EMR programs, in many cases linked to provincial fee negotiations.
I would like to see a future with strong national EMR vendors competing vigorously for clients and innovating aggressively to enhance product features in order to deliver more efficient and higher quality care. Under the current systems and processes, I cannot see this happening without some fundamental changes in the way EMR systems are certified and sold. The alternative is less attractive. Canada will lag behind the U.S. in adoption and use of EMRs. Why? Because just as in the Crowdfunding business, the U.S. has a national regulator and strategies to encourage competition and sales of EMR systems across the entire market. Canada is just not ready to take that kind of leap of faith.
What is necessary to create a healthy competitive EMR market in Canada? Share your thoughts by clicking on the “Comments” link below.