Why can't we Accelerate EMR Adoption in Canada?

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:

1. Failure of policy.
2. 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.)
3. Persistent gaps in the system (In particular, the ability to electronically prescribe medications)
4. 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.

Do you agree or disagree? To share your opinion, click on the 'Comments' link below

Comments

[twitter.com/robschertzer]

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.