The state of electronic health records across Canada

If the health records of Canadians were a music collection, we'd still be dealing with vinyl.

According to Canada Health Infoway — the not-for-profit organization funded by the federal government to move health records into the digital age — every year, Canadians visit doctors' offices 322 million times. Around 94 per cent of those visits result in handwritten paper records.

'Every year, Canadians visit doctors' offices 322 million times. Around 94 per cent of those visits result in handwritten paper records'

Your medical history likely consists of sheets of paper, old-style film-based X-rays and hand-scribbled hospital charts — all spread across whichever parts of the country you've lived in.

Canada lags behind most of the developed world in adopting electronic health records. In the Netherlands, 98 per cent of health records are electronic. New Zealand's not far behind at 92 per cent. The U.K. boasts an 89 per cent digital rate while Australia comes in at 79 per cent. Only the United States fares worse than Canada — among developed countries — although President Barack Obama has signaled that he wants the system to get serious about digitizing health records now.

The Canada Health Infoway is aiming to having 50 per cent of Canadian medical records available electronically by the end of 2010. It's about a third of the way there.

Implementation has varied widely across the country. Alberta has long led the way towards electronic health records in Canada. Of 4,404 physicians across the province, 3,154 had wired their practices by the end of May 2009. While some use their systems mainly for billing and scheduling patients, more than two-thirds — 2,158 physicians — used their systems to maintain their patients' health records.

Getting the ball rolling

In 2001, Alberta launched the Physician Office System Program (POSP), an incentive program to encourage doctors to automate their practices. Under it, eligible physicians are reimbursed 70 per cent of the cost of converting to a "paperless" office, including hardware, software and increased networking costs.

Under the program, companies that want to sell eHealth software must adhere to Vendor Conformance and Usability Requirements. They lay out the standards software has to meet for:

• The handling and security of Electronic Medical Records. 
• Access to clinical information.
• Continuity of care.
• Clinical decision support, privacy and confidentiality.
• The billing/claim validation process and business stability.

Physicians also have to outline to the province's Information and Privacy Commissioner how they plan to protect patient information.

It was the first program in the country to offer financial incentives for doctors to go electronic. Since then, B.C., Saskatchewan, Manitoba, Ontario, and Nova Scotia have set up their own programs requiring vendors of EMR software and equipment to meet standards to sell their wares in that province. Manitoba's program, however, does not help physicians pay the cost of converting.

In B.C., the government is aiming to encourage 4,000 - 4,500 out of 6,000 eligible physicians online by 2012. As of April 1, 2009, 2,000 physicians had applied and enrolled in the program. By the end of May 2009, 210 physicians had gone live.

Figures for other provinces with an EMR program include:

• Saskatchewan, where just over a fifth of the province's 1,400 eligible physicians have gone electronic.
• Manitoba, where around 10 per cent of 1,700 eligible physicians have set up electronic medical record systems.
• Ontario, where four million out of 13 million people are expected to be covered by an EMR system by the end of 2009.
• Nova Scotia, where just under a third of eligible physicians are using EMRs and three per cent of physicians had implemented EMRs before or outside of the program.

In Newfoundland and Labrador, five per cent of doctors have gone digital, without an EMR program.

Quebec, Prince Edward Island, New Brunswick and the three territories also do not currently have a provincial certification and/or funding program for EMR software.

Initial costs can be steep

Going digital isn't cheap. A Toronto doctor has chronicled her voyage from an old-fashioned paper office to a modern digital office. Dr. Michelle Griever estimated it cost about $30,000 for software and hardware to make the initial switch. She estimates ongoing costs of about $3,000 a year to maintain the system.

However, she notes that there's a cost to sticking with paper — including filing cabinets, paper, the time it takes staff to handle paper, as well as the inefficiencies that misplaced or lost files cause.

A digital doctor's office is just one step towards an electronic healthcare system. That wired office needs to be able to communicate with the clinic that took your X-ray. In December 2007, Newfoundland and Labrador's department of health announced that it had reached its goal of "having more than 95 per cent of diagnostic images available digitally throughout the province to authorized health care providers."

Newfoundland and Labrador became the second province to establish a province-wide Picture Archiving and Communications System (PACS). It allows diagnostic images such as X-rays, MRI, ultrasounds and CT scans to be captured, transmitted and stored digitally. The images can be taken at a hospital in a remote part of the province and read by a clinician at any equipped site in the province. But not in your family doctor's office — even if it's wired. At least not yet.

Canada Health Infoway says 80 per cent of Canadians should be covered by PACS by the end of the current fiscal year. When the system covers the entire country, it's expected to save around $1 billion a year.  The agency estimates that seven to 15 per cent of all diagnostic imaging exams are unnecessary duplications because a specialist couldn't find lost or unavailable images.

Also on the wish list by March 31, 2010 is having 75 per cent of laboratory information and 75 per cent of prescriptions in electronic format.

The agency wants all Canadians to be covered by electronic health records by 2016. It says that will save the healthcare system $6 to $7 billion a year but will require a one-time investment of $350 per Canadian. So far, the federal government has kicked in about $50 per person.