The Romanow Report & Informatics

On November 28, 2002 the Commission on the Future of Health Care in Canada delivered its Final Report to Canadians.

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 Canada’s 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

Report Highlights


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 savings

In contrast, electronic health records provide important advantages.

• 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 individual’s 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 chronic illnesses.

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 Report)

  • RECOMMENDATION 8: A personal electronic health record for each Canadian that builds upon the work currently underway in provinces and territories.
  • RECOMMENDATION 9: Canada Health Infoway 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.
  • RECOMMENDATION 10: 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.
  • RECOMMENDATION 11: 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.
  • RECOMMENDATION 12: 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.


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