Electronic health records aren’t exactly the sexiest of topics; they are easily overlooked amidst the furor over our new Prime Minister and his ambitious plan for “real change” in Canada. But think of it this way: everyone loves new technology. The demand for technological skills is through the roof in almost every job market. So why then is it acceptable for many doctors to continue scribbling away in illegible cursive in a paper file folder—instead of using recording files electronically?
We can access our banking information, school records, and even family photographs from our phones, but to find some of our most important personal information – our health history–someone has to climb a step ladder in a room full of shelves to pull a paper file from a dusty box.
How is it that we’ve allowed our medical industry to fall so far behind the technological curve?
Health policy is a provincial responsibility according to the constitution. While interprovincial coordination was always a concern, in 1867 there may have been a lack of foresight into the importance of modern technology to the field of health care – not to mention the cost or new challenges it might bring to Canada. Today, the cost and difficulty of running a health system with the most up to date technology is not within the grasp of the provinces alone. The likelihood that 13 subnational governments would be able to coordinate 13 complex electronic health records IT systems that integrate with each other perfectly without the assistance of the federal government is slim, to say the least.
Canada desperately needs a national electronic health strategy in order to ensure the provinces coordinate their ehealth system and allow critical health information to move across provincial borders as people move.
Portability ensures that Canadians have equitable access to medical care across the country regardless of their province of residence. It is one of the fundamental principles in the Canada Health Act. And while portability refers to access to care, health records, by providing accurate medical history, allow health care professionals to provide the highest possible level of care. Without a national electronic medical health records system, health care professionals are limited in their capacity to provide every patient with an equitable level of care.
This can be an issue in extreme cases if someone is injured outside of their province of residence. But more importantly, job markets and education requirements have led people, often young people, to become much more transient, often living in multiple provinces throughout their lives. People move frequently around this very large country and their medical health records should move with them.
Recently, I had a routine doctor’s appointment. I was interested to see my doctor typing as I chatted with her. But upon asking to see my electronic health record, she revealed that it was blank since it was my first appointment in Ontario and she was starting a new health record for me. Given that it was a routine appointment and I’m reasonably healthy, it was not a problem. But in the event of an emergency an electronic health record could provide doctors with life-saving information such as allergies or known medical conditions. If this information is available to health care professionals in my home province, under the principle of portability, it should be available to doctors throughout the country in order to ensure a consistent level of care.
More dramatically, a man who recently moved from Alberta to British Columbia was forced to submit multiple freedom of information requests to his former health care providers in order to obtain his entire health record – a process that is both timely and costly. Having this type of incident happen in Alberta is particularly worrisome as health care experts often laud the province’s Netcare system as the best electronic health records in Canada. If the best system in the country can’t coordinate with other provincial systems, portability is all but non-existent in terms of electronic health records.
The Harper Government did make some headway when it created a not-for-profit organization called Infoway, which focuses exclusively on using digital solutions to improve health care delivery. Infoway also estimates that over 90 per cent of physicians use some form of electronic health record-keeping. However, the question still remains: how can the provinces coordinate in order to ensure that critical health information is permitted to move across provincial borders?
Infoway launched their interoperability action plan earlier this year which seeks to promote more movement of digital health solutions. The program lacks a cohesive and concrete plan of how it intends to coordinate 13 different ehealth systems at different stages of development, which were criticized in 2010 by the Auditor General of Canada for being fundamentally incompatible with each other. It does not acknowledge that many provinces have multiple systems within their borders nor does it discuss how to manage privacy concerns. The interoperability action plan is a good start but needs stronger direction from the central government if there is any hope of success. Looking at how ServiceOntario coordinated back office processing for several major ministries, including health, might be a good starting place as it synchronized several different IT systems. However, it must go beyond that and incorporate serious online privacy measures.
Canada needs a national electronic health strategy in order to ensure portability is upheld to the highest standard. Mr. Trudeau stated that he wants to negotiate a new health accord and better manage health policy with the provinces during his election campaign but, notably, never the Liberals never discussed ehealth. Perhaps this is due to a poor political appetite amongst voters after major major failures in provinces such as British Columbia and Ontario. But now that Trudeau has been sworn in as Prime Minister, let’s hope he prioritizes more accessible health solutions and provides stronger leadership on an issue doomed to fail without a champion.
Katie Bowers is a 2017 MPP candidate at the University of Toronto. Previously, she completed an undergrad in Political Science at UBC and worked as an intern the BC Legislature. She is interested in health policy, foreign policy, international development, and travelling around the world.