Study: Canada needs to clarify e-health vision

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To accelerate adoption of EHRs and realize a timely return on investment in Canada, an e-health policy needs to be tightly aligned with the major strategic directions of healthcare reform, according to a recent study published Feb. 22 in the Canadian Medical Association Journal.

Doctors and front-line healthcare workers and administrators must be encouraged to play a more active role in EHR implementation, wrote Robyn Tamblyn, MD, medical scientist at the Research Institute at the McGill University Health Centre (MUHC) in Montreal, and colleagues.

The Canada Health Infoway project was implemented in 2001 with the goal of accelerating e-health implementation and creating a national system of interoperable EHRs. After 10 years and $1.6 billion of investment in 280 health IT projects, Canada still lags behind countries such as Denmark, the United Kingdom and New Zealand, according to Tamblyn, who is also a professor at the departments of medicine and epidemiology, biostatistics and occupational health at McGill University, and colleagues.

The researchers assessed the effectiveness of Canada Health Infoway’s e-health plan by interviewing 29 key stakeholders representing national and provincial organizations in Alberta, British Columbia and Ontario. The results showed that Canada Health Infoway has been somewhat successful in setting up standards and developing a plan for provinces to compare notes and share resources, but that more work needs to be done to improve and expedite implementation of health IT to support challenges in delivering the best care for all Canadians.

Participants highlighted the benefits of having a comprehensive national approach to the standards for health IT that set the foundation for interoperability in the future and that establish a framework for collaboration across provinces and territories.

“The release of funds in accordance with performance benchmarks was also a feature of the Canada Health Infoway plan that was seen as an enabler of provincial buy-in and commitment,” the researchers found. “In terms of clinical applications, digital imaging was viewed as the most successful, providing benefits for patients and reductions in cost.”

Two major initiatives were viewed as less successful: An e-health policy that would foster effective strategies for adoption by clinicians; and the implementation of the national infrastructure for EHRs. For the first, Canada Health Infoway was seen as a funding agency, not a policy-setting body. “Moreover, inadequate attention to clinicians was viewed as a critical ingredient missing from the e-health vision,” wrote the authors.

To accelerate adoption, participants identified four key requirements: Meaningful engagement of clinicians; coordinated leadership and investment in EHRs across the country in conjunction with provincial, professional and regulatory authorities; a revised payment model that would provide financial incentives based on patient outcomes that can be achieved with the use of EHRs; and a focus on technology that would improve the value of healthcare.

A key finding that emerged was the absence of an e-health policy to align the investment in IT with the priorities of the healthcare system and of healthcare providers in order to accelerate adoption and achieve early return on the investment. In non-health sectors, past failures and suboptimal rates of return from investment in IT have been attributed to poor alignment of priorities with corporate objectives and strategies; this problem also appears to exist in the health sector.

“Canada has implemented a national strategy for interoperable EHR by establishing a model for successful interprovincial collaboration on core aspects of a national framework,” the authors concluded. “Looking forward, Canada needs to establish an e-health policy to guide the implementation of health IT to address the major strategic priorities of healthcare reform and to promote the adoption of EHRs and exchange of clinical data to address these challenges.”