Report & Informatics
On November 28, 2002 the Commission on the
Future of Health Care in Canada delivered its Final Report to
On April 4 2001, Roy Romanow was appointed by Prime Minister
Jean Chrétien to head the Commission on the Future of Health
Care in Canada. The Commission's mandate is to recommend policies
and measures to ensure the long-term sustainability of a universally
accessible, high quality, publicly-administered health care system
for all Canadians.
One of the highlights of the report was to encourage the development
of a national personal electronic health record system.
Mr. Romanow accords the increased use of information technologies
of such great importance that he chose to place his recommendations
on informatics at the beginning of his report:
"Some might wonder why a chapter on information would figure
so prominently and be placed at the beginning of a report on the
future of Canadas health care system. The answer is that
leading-edge information, technology assessment and research are
essential foundations for all of the reforms outlined in subsequent
chapters of this report." - Roy Romanow
|Paper records are increasingly becoming obsolete
and inadequate. They limit the flow of information, insufficiently
document patient care, impede the integration of health care
delivery, create barriers to research, and limit the information
available for administration and decision making.
|As one health region
described it, roughly 30% of nursing time is spent managing
paper records. Just a 5% reduction in the time nurses
spend doing charts could free up the equivalent of 90
nursing positions and generate $5 million a year in
In contrast, electronic health records provide important
Diagnoses, treatments and results can be improved when
health care providers have access to complete personal health
information and can link that information to clinical support
tools. In a recent survey from the Canadian Medical Association,
over 76% of physicians agreed that improving how patient information
is shared is an important or very important potential benefit
of electronic health records. Further, 68% agreed that the use
of electronic health records would result in improvements in
clinical processes, efficiency of workflow, and continuity of
care. Almost 60% said that electronic health records would improve
the quality of care.
Accuracy of personal health records can be improved.
With an electronic health record, information from a variety
of health care providers is collected and stored on a single
record, providing a more complete and more accurate record of
an individuals personal health history.
Efficiency can be improved. As one health region described
it, roughly 30% of nursing time is spent managing paper records.
Just a 5% reduction in the time nurses spend doing charts could
free up the equivalent of 90 nursing positions and generate
$5 million a year in savings. They also point to potential efficiencies
in managing chronic diseases by targeting efforts to expand
electronic health records at the primary health care level.
Electronic health records provide aggregate data that
can be used in health research and in health surveillance, tracking
disease trends and monitoring the health status of Canadians.
Security can be improved. From the point of guaranteeing
necessary access to health records, precautions need to be put
in place to ensure that electronic health records do not become
an obstacle when accessing health services. Necessary safeguards
must be in place to ensure that a network crash never serves
as an obstacle to obtaining necessary care. Furthermore, electronic
health records bring together a host of health records that
were previously physically dispersed into a new comprehensive
format. This change will have important implications in terms
of the physical security of personal health information.
With a complete system of electronic health records in place,
there are some important benefits for individual Canadians, for
health care providers, researchers and the system as a whole.
Individual Canadians would have secure on-line access to their
personal electronic health records. One potential scenario could
involve the development of a Web site to access personal electronic
health records similar to on-line banking, where individuals could
log onto the system using a personal identification number. At
the click of a mouse, they would have access not only to their
personal health information but also to a broader base of general
information on health issues. With this information, individuals
can play a more direct role in managing their own health.
Health care providers would have access to clinical decision
support tools to assist them in making decisions based on the
best available evidence. Health care providers would be able to
access patient records at the point of a clinical encounter. It
would help manage the massive amounts of complex health information
and ensure that health care providers have complete and accurate
information about patients health and health care histories.
It also would improve physicians ability to access the latest
information, select the best course of action, and use evidence
to guide their decisions.
Researchers and policymakers would have access to aggregate data
compiled through the electronic health record system. These data
could be extracted generically for health research purposes, without
being linked to any individual electronic health record. The Commission
understands that researchers would, in many cases, prefer to have
access to person-oriented health information to allow
them to track certain illnesses or health-related factors over
time. Only when there are sufficient safeguards in place and the
system has demonstrated its ability to protect the privacy of
individuals, should researchers have access to person-oriented
data. This information could be used to monitor and measure outcomes
and allow increased health surveillance in the management and
treatment of particular diseases, especially for patients with
Finally, the overall quality of the health care
system can be improved. The electronic health record system would
enhance the ability of health care managers and researchers to
identify and respond to medical errors or problems that occur
in the health care system, and improve patient safety and quality
of care. Currently, problems in the health care system related
to patient safety are not well monitored or identified for a host
of reasons including the lack of information technology to monitor
and track errors and also the fear of blame and litigation.
Building Canada s Health Information Technology Infrastructure
(recomendations from the Romanow
A personal electronic health record for each Canadian that builds
upon the work currently underway in provinces and territories.
should continue to take the lead on this
initiative and be responsible for developing a pan-Canadian
electronic health record framework built upon provincial systems,
including ensuring the interoperability of current electronic
health information systems and addressing issues such as security
standards and harmonizing privacy policies.
Individual Canadians should have ownership over their personal
health information, ready access to their personal health records,
clear protection of the privacy of their health records, and
better access to comprehensive and credible information about
health, health care and the health system.
Amendments should be made to the Criminal Code of Canada to
protect Canadians privacy and to explicitly prevent the
abuse or misuse of personal health information, with violations
in this area considered a criminal offense.
Canada Health Infoway should support health literacy by developing
and maintaining an electronic health information base to link
Canadians to health information that is properly researched,
trustworthy and credible as well as support more widespread
efforts to promote good health.