Experts call for health infoway “watchdog”
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* Paul Christopher Webster

Dismal Canadian progress in the development of national electronic health records, as evidenced by a recent report on ehealth from the World Health Organization (WHO) that ranks Canada 21st in information technology development, underscores the need for an independent, national “watchdog” to assess government ehealth efforts, experts say.

“From an accountability perspective, the public should have some awareness that we’re not as far along as we would like to be or as they think we are. And secondly, that somebody is paying attention and making sure that we are progressing in the right direction and at a reasonable pace,” says Dr. Brian Postl, dean of medicine at the University of Manitoba in Winnipeg and chair of the Canadian Institute for Health Information (CIHI) board of directors. “I believe that’s what the public deserves.”

Louis Barré, CIHI vice-president (strategy, planning and outreach) argues that Canada must adopt new and better measures to track and assess national ehealth efforts in order to ensure that the national investment in ehealth properly addresses “the real paucity of clinical systems” that currently exists, as well as long-term strategic issues such as the need to ensure that ehealth systems can be employed for medical research. “We are going to need to have a better sense of where we are at now, to build out a meaningful strategy.”

Postl and Barré advocate the commissioning of an independent body to assess and report on government efforts — perhaps with arm’s-length assistance and funding from an agency or department such as CIHI, the Canadian Institutes of Health Research (CIHR) or the Health Council of Canada.

There’s a need for better tracking and monitoring of ehealth by analysts independent of government, concurs Dominic Covvey, president of the National Institutes of Health Informatics (NIHI), a Canada-wide network of 151 ehealth researchers who collaborate within a “virtual institute of institutes.”

![Figure1](http://www.cmaj.ca/https://www.cmaj.ca/content/cmaj/183/3/298/F1.medium.gif)

[Figure1](http://www.cmaj.ca/content/183/3/298/F1)

Canada’s progress in the development of a national electronic health record system has been “very slow” and “pretty incomplete,” says Dr. Brian Postl, dean of medicine at the University of Manitoba in Winnipeg and chair of the Canadian Institute for Health Information board of directors.

Image courtesy of Canadian Institute for Health Information

Canada needs an ehealth “watch-dog,” says Covvey, who notes that Canada Health Infoway, the federal ehealth agency, faces growing criticism for strategies that have left the nation trailing other nations in ehealth development, despite 17 years of planning and at least $4 billion in federal and provincial spending.

“Infoway has no evaluation mandate,” Covvey adds, charging that any evaluation of ehealth performance that occurs within Canada Health Infoway amounts to little more than “government evaluating itself.”

Robyn Tamblyn, health informatics researcher at McGill University in Montréal, Quebec and leader of a CIHR-funded team that investigates the use of ehealth technologies to support integrated care for chronic disease, says the recent WHO snapshot suggests that a much closer look at Canada’s ehealth policies and progress is now warranted.

By providing impartial information, a current state assessment will allow policy-makers to substantiate official claims, Tamblyn argues. A thorough assessment will also help steer ehealth development toward patient-centred solutions and foster such innovation, she argues. “Policies are needed to support research and translation of local successful initiatives [within] a ‘bottom-up’ approach.”

“To avoid unnecessary political wrangling,” Tamblyn recommends the effort be conducted under the rubric of the CIHR in order to achieve “objective, systematic collection of empirical information.”

The calls for an independent assessment of Canada’s ehealth efforts follow in the wake of the WHO report that ranked Canada 21st in terms of information technology progress among 159 nations — just ahead of Estonia, but well behind much of Scandinavia, Europe, and the Republic of Korea ([www.who.int/goe/publications/goe\_atlas_2010.pdf](http://www.who.int/goe/publications/goe_atlas_2010.pdf)).

*The report, ATLAS eHealth country profiles*, concludes that Canada’s ehealth deficiencies include a lack of supportive federal laws and regulations, national procurement and technology policies, educational policies and scholarships, and evaluations to monitor progress on important areas such as the capacity to deliver health information to patients via mobile telephones.

The WHO snapshot of Canada is “worrisome,” says Postl. “It’s been very slow progress and remains pretty incomplete.”

Among the alarming indicators in WHO’s profile of Canada, Postl says, are a set of barriers to elearning within medical education at a time when “we’ve got a gap between the expectations and growing skill sets of our students who now live and breathe in the electronic world by second nature, and our educational systems that are kind of catching up. … The students know they can’t provide effective and safe care with the paper and pencil system where charts disappear.”

The WHO profile indicates the time has come for a much more detailed and comprehensive review of Canada’s ehealth status, he adds.

Canadians are often “stunned” to discover that basic health information technologies are unavailable, Postl argues. “I think the public thinks that much more exists than actually does exist.”

“Do we know what is happening? The answer is no,” says Barré. “A current state assessment would be very helpful.”

Infoway has struggled to meet such goals as a commitment to ensure that health professionals have access to health records for 50% of Canadians by 2010. Kirk Fergusson, Infoway’s vice president, corporate affairs, told *CMAJ* in January that the goal has been achieved for 49.3% of Canadians. But he did not respond to a request for a data breakout to elucidate how that figure was derived.

Tamblyn argues that Canada also needs to develop an ambitious new basket of national policies to galvanize ehealth progress. The policies should facilitate timely clinical information-sharing between providers in all settings, make personal health records and self-management tools accessible, enable reimbursement for evisits, enable interdisciplinary teamwork and provider consultation, establish incentives for using electronic reminders for preventive care and personalized health care, and implement patient outcome-based financial incentives, she says.

Canada Health Infoway declined to comment on the WHO atlas and referred questions to Health Canada.

David Thomas, spokesman for Health Canada, says “the timing of the WHO survey in 2009 coincided with advance planning for H1N1, a public health priority in Canada, so unfortunately not all of the provinces and territories were able to provide input to the survey. In addition, as with any survey, there are limitations, which include the interpretation and applicability of the questions.”

Thomas also notes that “ehealth applications were difficult to assess, and the responses provided may not apply equally across the country.”