Discussion Paper on Electronic Health Records in Canada

Megha Patel
York University
EHR adoption is currently one of the most discussed topics in the
healthcare sector. Canada made it its point to implement the EHR and has
gone through rough patches with the same. This paper presents several
concepts related to the implementation of the EHR in the country. It
focuses on the probable benefits of instituting such a system, extent to
which this program is being used in Canada, evidence of its positive and
negative impact on health care, some of the barriers to instituting
EHR’s and how these can be overcome. It also analyzes the pace of
EHR’s implementation in Canada in comparison to other countries, the
reason behind current level of its implementation in the country and
ways of shifting from the slow pace to a faster pace.
Electronic Health Records in Canada
Information technology is one of the most important parts of health care
systems globally. It has improved health care systems by enhancing
functionality, accuracy and is a strategic way to manage health records.
There are many ways through which IT is integrated in today’s health
care systems and Electronic Health Record (EHR) is one of them. It is
generally a collection of core data from multiple sources and it may
comprise different e-records, submitted by different providers in
different jurisdictions (CMPA, 2008). This paper will focus on the
probable benefits of instituting such a system, extent to which this
program is being used in Canada, evidence of its positive and negative
impact on health care, some of the barriers to instituting EHR’s and
how these can be overcome. It will also analyze the pace of EHR’s
implementation in Canada in comparison to other countries, the reason
behind current level of its implementation in the country and ways of
shifting from the slow pace to a faster pace.
Benefits of Electronic Health Records
Gone should be the days of 19th century when in the entire health care
system, all the records and prescriptions were paper based. When
patients went to hospitals they would have to carry documents and x-rays
in big envelopes. This led to several problems including not being able
to recover important information, misreading information due to
legibility, poor transitions where critical information could be left
behind when a patient moves from one healthcare setting to another, cost
of repeated tests due to lost records were some of the many issues that
the health care system has faced so far.
But we are in 20th century now and innovation has surged in different
sectors like never before. Health care systems should be no exception to
taking advantage of the new innovative techniques and programs (Urowitz,
2008). Being one of the most information concentrated systems in the
world, it accumulates enormous amount of data in its ever growing
database. Electronic health record system is a solution to endless
troubles faced by patients, physicians and health care practitioners
around the world. Electronic health records will give physicians and
patients the ability to access their medical information or history from
anywhere in the country regardless of how old the information is
provided that the data was entered into the system is not lost.
Physicians will have the ease of updating the records during every
visit. It will be cost efficient since it will eliminate retesting, be
time efficient and accurate in comparison to traditional paper records.
Implementation of Electronic Health Records in Canada
Compared to other OECD countries such as New Zealand, U.K, Netherlands
and Australia, Canada has been relatively slow in terms of
implementation of electronic health records. Barron & Manhas (2011) make
this clear by stating that according to a study by the Commonwealth Fund
carried out in 2009, Canada has only 37% of its physicians using EHR
systems as opposed to 99% in Netherlands. Similar disparities are
recorded when comparing Canada to the United Kingdom and New Zealand
with the former having recorded 96% usage while the latter had 97% usage
(Barron & Manhas, 2011). Barron & Manhas (2011) state that in Canada,
most of the EHR usage is confined to “electronic billing and
scheduling care rather than to patient care”.
Although there have been efforts from Canada Health Infoway (CHI) in
developing and implementing EHR through all the Canadian provinces,
it’s running behind schedule. Its aim was to have fifty percent of
Canada’s medical records available electronically by 2010 but it’s
only about one third of the way there” (Hadzipetros 2009). The way CHI
works is by approving all the projects ensuring that all the provinces
adhere to the blueprint and comply with all the standards. It funds the
projects using its own funding model and establishes legal agreements
for each project with the provinces and territories. One of the weak
points is that Infoway does not obtain the results confirming the
successful completion of tests on the EHR system implemented which
consequently does not give enough assurance to Infoway about the
compatibility of EHR systems across the country (EHR in Canada, 2010)
Research carried out by Barron & Manhas (2011) look into some of the
reasons why the pace of implementing EHR has been slow in Canada. These
reasons vary and cover structural, monetary, human resources issues
among others. Barron & Manhas (2011) state that in some instances
patient record integration across several healthcare providers is
difficult and therefore the implementation of the system is associated
with little benefit. Barron & Manhas (2011) also state that the costs of
implementing the EHR has been quite high and therefore cost overruns
have stagnated its development and implementation to the full fledged
EHR desired by medical institutions. Barron & Manhas (2011) state that
there have been doubts about the improvements being made to the Canadian
EHR system and as a result, its intended users and implementers have
doubted its ability to bring desired returns on the investment. Barron &
Manhas (2011) state that the implementation of EHR is done through
various projects and that some of them suffer negatively because of cost
overruns, crashing computers, and dehumanization of care.
The EHR in Canada has also been delayed by breaches in privacy and
confidentiality. Barron & Manhas (2011) state that there are
legislations that govern privacy and confidentiality including the
eHealth Personal Health Information Access and Protection of Privacy Act
commonly known as the eHealth Act, the Freedom of Information and
Protection of Privacy Act and the Information Protection Act. Barron &
Manhas (2011) state that even with these Acts, Canada has witnessed
security breaches that have hampered its development of the EHR. Barron
& Manhas (2011) claim in Alberta, people were able to hack into the
system and view the records of about 11,000 people. Barron & Manhas
(2011) also state that in Toronto, healthcare organizations were seen to
discard sensitive information carelessly leading to possibilities of
“identity theft”. These two scholars also state that a similar
occurrence took place in Ontario where 50 dumpsters exposed the
information of over 100 patients. These problems have been compiled by
inadequate personnel and monetary issues as mentioned earlier on thus
delaying EHR implementation.
Another problem linked to the extensive delays in fully enacting the
desired national EHR system in Canada is lack of political will. Webster
(2010) states that the steps taken to implement the EHR in Canada lack
federal governance. He states that the successful implementation of the
Canadian EHR system is dependent on sound leadership from the political
front and the maintenance of national standards that are coherent.
Webster (2010) claims the Canadian government has not been on the
forefront in ensuring that the required standards are applied in the
implementation of EHR plans. He states that the government has not made
the implementation of EHR a priority and therefore it has not been as
successful as it should be at this stage. Webster (2010) goes ahead to
state that the government must figure out how to ensure the standards
are adhered to. The government is also stated by Webster (2010) as
having relaxed its inspection procedures when it comes to the policing
of healthcare data management systems and electronics. To add to this,
Webster (2010) states that vendor which is Infoway has not ensured that
the EHR systems across the provinces comply are unified and that the
company feels it is not their task to ensure the different provinces
comply with the given standards. Webster (2010) also states that the
unparallel developments in the different provinces are determined by the
developments of each province and therefore provinces that move faster
experience faster and development towards EHR adoption compared to
Besides some of the solutions mentioned in the above paragraph with
regard to government involvement and policy formulation, there are also
other solutions. The government should more to ensure that the standards
for EHR equipments and other policy standards are adhered to because may
assist in the avoidance of security and privacy breaches. The vendors,
users and other involved stakeholders should also ensure they play their
parts in enacting the EHR in Canada.
Political will and responsibility coupled with the other changes
mentioned above will assist Canada to develop its EHR system into a
world class one just as those implemented by other nations it was
compared with earlier on in this essay. Good steering from the
government will ensure that funds for the whole project are disseminated
as required and that problems arising from money shortages do not arise.
When IT was first being integrated into the health care system, lack of
financial resources was considered as one of the most important factors
leading to slow implementation of EHR systems across the country. As the
years progress government has committed itself to provide funding and
increase provision of all the needs in order to facilitate successful
EHR implementation across country but it can certainly do more.
More responsibility on the parts of the vendors will also lead to the
success of implementing EHR in Canada. Clinicians also ought to receive
better education on the importance of EHR and how they can use the same.
computer literacy and the use of computers in healthcare is something
clinicians may not be used to and education on the same is steadily
improving attitudes but there is room for improvement.
Issues related to Electronic Health Records
After so much criticism on the government’s role and its ability to
spearhead the process of implementing the EHR, the Canadian government
is positively responding to the situation. Even after all the necessary
financial and educational support being offered one would still ask why
more than half the country is still not using EHR? That is because
moving to EHR in its complete form is not just a technical innovation
it is a cultural transformation. In the words of one presenter, all of
us – providers and managers in particular – “need to complete the
transition from resistance to electronic information (historical
position) to acceptance (current position) to addiction (can’t
function without it)” (EHR in Canada, 2010))
Some of the key issues of Canada`s current health care system are long
wait times, Primary health care with interdisciplinary teams providing
complete, convenient care with an increased emphasis on health promotion
and prevention, enhanced patient safety in the community and
institutions, improved quality of care, particularly for people with
chronic conditions and improved efficiency and better value for money.
(Canada Infoway & Health Council of Canada. 2006)
EHR has the potential to reduce these problems significantly. Here are
some of the features of EHR system for example and ways they can make
Canada`s health care more efficient. One of the elements of a fully
functional EHR is automatic call reminders to patients which reduce the
time consumption in the process of notifying patients to go for their
regular checkups. In Laboratories it can eliminate naming and other
written errors on samples and other materials to be tested which might
cause immense delays for important reports If the prescriptions were
electronic then they could be directly forwarded to the pharmacies.
Pharmacists giving the prescribed drugs can add a reminder for
follow-ups for consultation and refills which will enhance patient care
while making the process time efficient and easy (Canada Infoway &
Health Council of Canada, 2006)
In EHR implementation, fear unmeasured accessibility leading to misuse
and security of records is also one of the concerns. People want access
to their personal health records and that raises the concern for the
policy makers as to how to keep the information secure. Since the
information is being collected from several different sources and there
is a high number of people who want to access the information it is
potentially unsafe for certain data to be kept open and difficult to
manage restriction to the available data and this may lead to situations
such as those discussed earlier in this research.
Positives and Negatives of Electronic Health Record in Canada
Several advantages come with the adoption and use of EHR. Barron &
Manhas (2011) state EHR leads to more positive health outcomes. They
state the EHR is associated with higher patient safety and reduced
waiting times and these have major effects on healthcare outcomes. For
example, the amount of time patients wait for their information to be
retrieved determines how soon they will be treated and this makes a
difference for them. As noted earlier on, people also do not have to
move around from one doctor to another with envelopes lab results and
other medical documents.
The above point is closely knit to increased accessibility as identified
by Barron & Manhas (2011). EHR makes it easy for physicians to access
patient information from wherever they are and to share information
throughout the system. This means that doctors in interconnected
healthcare facilities do not need to go through too much trouble to get
patient information.
Barron & Manhas (2011) also claim that EHR positively impacts the
“integration of categories in healthcare”. This means that different
departments can easily coordinate in ensuring that patients get quality
care. For instance, there can be easy coordination between the
physicians and the specialists such as physiotherapists and other areas
that need to be integrated. The information is also retrieved
immediately and accurately and this ensures that patent safety standards
are held up high. Aspects such as the administration of medicine are
done with more precision through the EHR.
Cost efficiency is another positive outcome in using EHR. Several costs
are associated with a non-electronic health record system. The first
cost is associated with printing material on which patient information
should be recorded. To add to this, more personnel have to be employed
to keep records orderly and to retrieve them. This is costly because
these people have to be paid yet the cost of maintaining them in
hospitals is quite expensive if calculated per annum and in the long
Though cost cutting is an advantage as explained above, it can also be a
negative effect in the implementation of EHR. Some experts have
estimated the total cost of implementing EHRs Canada-wide at over $10
billion and the total annual benefits at $6 billion. (EHR in Canada,
2010) but the fact that EHR implementation standards are unknown for the
provinces and territories that are implementing them makes it harder to
assure the systems compatibility across country. If all the available
finance to the province and territories is being used in implementing
incorrect standards of EHR it is going to require more financing later
to adapt to a compatible version which in turn might further decrease
the pace of EHR implementation. This will result in loss of time and
money (Minister of Public Works and Government Services Canada, 2010).
Due to incomplete implementation of EHR systems physicians and other
health practitioners cannot take full advantage of what a complete EHR
system has to offer. This consequently decreases the efficiency of a
great system capable of making significant positive changes. Due to the
incomplete system`s inefficiency the physicians might not be able to
advance their understanding and learning of the system as well as they
would if the system was complete. This is bound to decrease the chances
of them becoming experts of the systems that they should be using for
the greater benefits of all.
The next negative effect associated with EHR is its susceptibility to
security breaches and leaking of confidential information. As discussed
earlier, this effect has already been felt in the Canadian healthcare
system. As noted by Barron & Manhas (2011) Canada has experienced
several security breaches and patient confidentiality has been
compromised to a great extent.
The EHR system is also said to make patient care non-personal and yet
that should be the case. The use of electronics in the healthcare
setting is said to come between patient-doctor/nurse contact and as a
result, the emotional aspects of patient care may not be met. Patients
such as those who need psychiatric care may feel neglected because their
doctors are focused so much on technology and not on them.
Effects and Involvement
In November 2011 when my 12 year old brother was hit by a car while he
was crossing the road on his bike on pedestrians signal, he needed to be
operated on his broken leg immediately. He was in pain, his left side of
the face was entirely bruised, his ear covered in blood and his eyes had
blood in them. His tears became invisible amidst the blood and wiping
them against his bruised face was certainly not an option. Because he
was half conscious he was so scared, full of fear and hardly able to
communicate anything. That was one of the most horrific and speechless
sights for me and for the first time after coming to Canada I was in
position to experience our health care system in hospitals.
The accident happened in the evening and the surgery was performed
around 1:00 am. For this entire time my parent`s state of mind seeing
their child in such a painful situation was unexplainable. This gave me
a close look at what it means to wait during emergency. Looking back at
that incident and thinking of hundreds of other people who might have
faced a similar situation, EHR definitely has the potential to reduce
waiting time for patients. The ripple effect of implementation of EHR in
other areas would lead to doctors and surgeons having more time to focus
on emergency situations.
After all the research and data provided it seems that the cultural
acceptance of EHR will play a major role in wide spread use of the
system. Everyone involved needs to understand that the system is
definitely useful and will be advantageous in the long run. Although
Canada has been fairly slow in modernization of its health care system,
the positive side is that at least the system is being implemented and
soon the country will be able to reap the benefits of the hard work.
Implementing a system that is time efficient, accurate, reduces
ineffectiveness in drug administration, reminds health care providers of
necessary tests and vaccines will benefit the country`s economy
including the creation of thousands of sustainable, knowledge-based jobs
throughout the country (Bellemare, 2009).
To conclude, the research above has tackled a number of issues. The
research highlights the progress made so far in line with adopting an
EHR system in Canada. The research has clearly outlined the numerous
benefits associated with the adoption of the system, the extent to which
it is being used in Canada and the negative aspects it comes with. The
benefits surpass the negative effects because the latter can easily be
minimized through strategic management. The research has also discussed
the pace of EHR implementation in Canada. The findings show that the
pace of implementation has been and still is slow even though there are
steady efforts targeting improvement in that direction. Improvements in
paces, as established in the research, will be the result of changes in
other quarters including policy formulation and implementation, attitude
changes plus others.
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