Earlier this week, Manitoba announced a $1 Million investment by Canada Health Infoway to create eReferral, “a tool to help primary-care providers refer their patients to an appropriate specialist and share necessary information through the patient’s electronic medical records”. According to Health Minister Theresa Oswald, “the objective is to roll out the program over the next two years, reaching over 1,000 family doctors, specialists and nurse practitioners who use electronic medical records”.
While the concept of eReferral is sound and necessary (eReferral and eConsultation have long been a critical deficiency in EMR strategies), development of a provincial referral system may solve one problem, but create another larger problem. Canada is made up of many small EMR markets. This creates challenges for vendors who are unable to market their products nationally, in any province, under a single national certification. By requiring vendors to conform to provincial certification requirements, each province adds to the challenge of EMR sustainability. Even small differences between provinces require vendors to maintain multiple versions of their products. The greater the difference, the more costly to maintain... and the differences are not small. Adding a Manitoba version of eReferral may solve one aspect of information exchange at the provincial level; however, it hammers another nail in the coffin of federation and makes standardized data interoperability more difficult to achieve.
Why is there no single eReferral standard for all EMR systems in Canada? Referring a patient in Manitoba is no different to referring a patient in Alberta or Nova Scotia. Why is no consideration being given to creating single national standards for critical processes such as eReferral that can be centrally certified for each EMR vendor... once? Funding negotiations between medical associations and provincial governments are not progressing smoothly. The Alberta POSP is in limbo and other provinces with negotiated EMR programs are having an equally difficult time convincing government that they should continue in present form. As a result, who is going to maintain and enhance certification standards as less and less funding is available for non-clinical purposes?
What are the barriers to simplifying the national and provincial EMR strategies?
- Technology is not the problem — eReferral has been done successfully in many other countries;
- Clinicians are not the problem — they have been asking for capabilities such as eReferral and ePrescribing for years;
- The EMR vendors are not the problem — they have been asking for a single national certification that enables them to sell their products across the country.
The absence of clear policy and a non-existant national roadmap has created an untenable situation. We should not be looking at the short term benefits of provincial solutions at the expense of national sustainability. Clinicians cannot afford it, EMR vendors cannot afford it and the citizens of this country cannot affort it.
What are your thoughts? Do you agree or disagree with this position? What are the potential solutions?
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