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The current state of electronic health records across Canada: an environmental scan and interoperability maturity
Sunand Kannappan1, Stephanie Hastings1, Alan Forster1
1Department of Medicine (Kannappan, Hastings, Manns), Cumming School of Medicine, University of Calgary, Calgary, Alta.; McGill University Health Centre (Forster); Department of Medicine (Forster), McGill University, Montréal, Que.; Alberta Health Services (Dean), Calgary, Alta.; Canadian Institute for Health Information (Hollett), Toronto, Ont.; Telfer School of Management (Hagens), University of Ottawa, Ottawa, Ont.; Hagens Consulting (Hagens), Toronto, Ont.; Canada Health Infoway (Gheorghiu), Toronto, Ont.; Networked Health (Affleck, Snyman); College of Physicians and Surgeons of Alberta (Affleck), Edmonton, Alta.; Canadian Medical Association (Adams), Ottawa, Ont.; Department of Community Health Sciences (Williamson, Manns), and O'Brien Institute of Public Health (Williamson, Manns), and Libin Cardiovascular Institute (Williamson, Manns), and Alberta Children's Hospital Research Institute (Williamson), and Centre for Health Informatics (Williamson), Cumming School of Medicine, University of Calgary, Calgary, Alta.
Background:
Canada has achieved near-universal adoption of electronic health records (EHRs) and yet interoperability, the secure exchange and use of health data across different systems and settings, remains limited. We aimed to describe the current state of EHRs in 10 provincial and 3 territorial jurisdictions in Canada and evaluate the maturity of their interoperability using a structured interoperability assessment model.
Methods:
We conducted an environmental scan of EHR use and interoperability across all provinces and territories using Canada Health Infoway documents and structured interviews with 23 subject matter experts. Using a rigorously designed interoperability maturity model, we evaluated jurisdictions across 4 enabler dimensions (governance, legislation and standards, incentives and capacity-building, and technical infrastructure) and 4 interoperability status dimensions (community EHRs, hospital EHRs, patient portals, and system analytics).
Results:
We found that, although EHR adoption was high, maturity of EHR interoperability was low and uneven across Canada. Integrated EHR health data exchange was limited, and nearly all jurisdictions lacked EHR interoperability between hospitals, community specialists, and primary care. Data exchange between primary care and specialists, and between hospitals and community settings, was heavily dependent on fax (traditional or online) or mailed letters in every jurisdiction. Patient portal contents and system-level analytics using EHR data were underdeveloped nationally. No jurisdiction was advanced in all dimensions. Although most jurisdictions showed strength in at least 1 area, they also exhibited many areas for growth. We identified 8 key barriers to interoperability, each of which can be overcome.
Interpretation:
Canada has widespread EHR adoption, but maturity of EHR interoperability and the enabling conditions required for true interoperability are low and inconsistent across jurisdictions. Strengthening governance, legislation, standards, incentives, and technical infrastructure - supported by national legislation to mandate interoperability across different EHRs - will be essential to advancing connected care across Canada and realizing widespread benefits for patients, clinicians, and health systems.
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