Canada Health Infoway

• Abstract
• Purpose of health policy or idea
• Characteristics of this policy
• Political and economic background
• Purpose and process analysis
• Expected outcome
• References

Abstract

The development of an interoperable electronic health record is being accelerated in Canada. Infoway, a non-profit corporation created and funded by the federal government of Canada in 2000, has as its focus the acceleration of the implementation of an electronic health record (EHR) on a pan-Canadian basis and the production of an EHR blueprint.

Purpose of health policy or idea

Currently the foundation of health service delivery in Canada is paper-based. Indeed, according to Infoway and the Health Council of Canada, about 94% of visits to physicians in Canada involve paper records and most prescriptions are handwritten. This creates inefficiencies (e.g. the duplication of tests), and heightens the possibility for drug interactions and prescription errors. Several organizations and provinces have developed targets for EHR coverage. For instance, the goal of Infoway is to have an interoperable EHR in place across 50% of Canada (by population) by the end of 2009. The Health Council of Canada envisions 100% EHR coverage by 2010. Several Canadian provinces have also established targets for EHR coverage. The province of Alberta, for instance, intends to have EHRs available for all Albertans by 2008.

Main points

Main objectives

Infoway is an independent, non-profit organization whose members are the 14 federal, provincial and territorial Deputy Ministers of Health. Infoway's approach is a strategic investment and partnership with stakeholders, including the private sector.

The Mission of Infoway is:

• To foster and accelerate the development and adoption of electronic health information systems with compatible standards and communications technologies on a pan-Canadian basis, with tangible benefits to Canadians; and
• To build on existing initiatives and pursue collaborative relationships.

Infoway has approved to date $702 million for 163 initiatives across Canada along nine main project themes: registries; diagnostic imaging solutions; drug information systems; laboratory information systems; telehealth; public health surveillance; interoperable EHR; innovation and adoption; and infostructure. Of the 163 projects, 103 were jointly developed with provinces and territories and 60 are pan-Canadian projects sponsored by Infoway.

Many provincial governments have earmarked funds to expand the coverage of EHRs. The provincial government of British Columbia, for instance, announced a $206 million dollar investment for the development of online computerized medical records for doctors in May 2006. The government of Quebec announced a $547 million investment to digitize medical records in April 2006.

Type of incentives

There are both financial and nonfinancial incentives for the development of electronic health records (EHRs). According to Infoway, EHRs would enhance system efficiency by providing authorized healthcare professionals with immediate access to their patients' accurate lifetime health histories, including laboratory and radiology test results, past treatments, prescription drug profiles and immunizations, while protecting privacy and confidentiality. EHRs also improve clinical decision-making "leading to more effective diagnosis and treatment, greater patient safety, increased efficiency and improved access to services".

Groups affected

Canadian patients and clients, front-line providers

Degree of Innovation	traditional		innovative
Degree of Controversy	consensual		highly controversial
Structural or Systemic Impact	marginal		fundamental
Public Visibility	very low		very high
Transferability	strongly system-dependent		system-neutral

Political and economic background

There is a strong support for EHRs by the federal and provincial governments and initiatives are currently underway across Canada to accelerate their development and implementation. In their 2003 First Ministers Health Accord on Health Care Renewal, for instance, the First Ministers agreed to invest in the continued development of secure electronic patient records which they deemed vital to public safety and the provision of quality care. Likewise, in their 10-Year Plan to Strengthen Health Care, the First Ministers supported the continued development and implementation of EHRs which would facilitate health system renewal in Canada. They also reaffirmed their commitment to working with Infoway "to realize the vision of the electronic health record through an ambitious plan and associated investment".

Purpose and process analysis

Current Process Stages

	Idea	Pilot	Policy Paper	Legislation	Implementation	Evaluation	Change
Implemented in this survey?

Origins of health policy idea

In 1997, the federal Minister of Health created an Advisory Council on Health Infostructure (ACHI) comprised of 24 representatives from the Canadian health sector. The mandate of the Advisory Council was the development of a Canadian health infostructure which would meet the various needs of specific categories of users. In its final report: Canada Health Infoway: Paths Towards a Better Health, released in 1999,  the Advisory Council developed a framework for a Pan-Canadian health infostructure (Canada Health Infoway).

In 2001, the Canadian federal government announced a $500 million investment which was granted to Infoway in order to foster and accelerate the development and implementation of effective, interoperable electronic health solutions. In 2003, an additional $600 million was earmarked for Infoway to accelerate the development of EHR and telehealth applications.

To date, the federal government has invested $1.2 billion in investment capital for joint projects with the provinces and territories along the nine targeted programs. The investment contribution is currently on average about 75% of project expenses with provinces and up to 100% with territories.

Initiators of idea/main actors

• Government

Approach of idea

The approach of the idea is described as:
renewed: The innovations around EHRs taking place in other countries, such as Denmark, England and New Zealand are being monitored by Canadians.

Stakeholder positions

The provincial and federal Commissions all supported the development of EHRs to improve system efficiency and promote quality of care. In November 2002, the Romanow Commission report, Building on Values: The Future of Health Care in Canada, explicitly called for the establishment of personal electronic health records for each Canadian building on the work currently underway in provinces and territories. Likewise, the Standing Senate Committee on Social Affairs, Science and Technology Report, The Health of Canadians: The Federal Role, called for the full integration of EHRs into health care delivery to ensure that patient data is available to health care providers and institutions on a need-to-know basis. There is a great deal of support for the creation of EHRs by the Canadian provinces. For example, the Saskatchewan Fyke Commission on Medicare called for the implementation of electronic health records to improve the efficiency, quality of care, and responsiveness of the Saskatchewan health care system.

Actors and positions

Government
Federal Government	very supportive		strongly opposed
Provincial Governments	very supportive		strongly opposed

Actors and influence

Government
Federal Government	very strong		none
Provincial Governments	very strong		none

Positions and Influences at a glance

Adoption and implementation

Infoway is fully operational and has provided investments for a wide variety of EHR solutions across Canada. However, one of the key challenges identified by Infoway and the Health Council of Canada in securing an EHR for every Canadian is communicating its importance as well as the issues around its realistic implementation (e.g. unstable costs) to top-level decision-makers. The Montebello Conference in 2006 was designed to address these challenges through an open dialogue between decision-makers and information technology and EHR experts. Another key component to the success of an EHR blueprint is cultural change; indeed, all stakeholders, including users of the system, need to be trained to optimize the use of EHRs.

Infoway also addresses the issue of privacy. Within its funding agreement Infoway is required to "incorporate the protection of personal health information in its activities in accordance with applicable laws and privacy principles". Each project supported by Infoway is required to conduct a Privacy Impact Assessment (PIA) that describes how the system will function and how it will address privacy rules in place in the jurisdiction.

Monitoring and evaluation

The accountability framework for Infoway is comprised of the following, all of which are made available to the public:

• An annual audit of financial statements by an independent auditor; 
• An Annual Report which includes performance results relative to the Corporate Business Plan and an overview of expected results; 
• An Annual Corporate Business Plan;
• An Annual Compliance Audit specific to the terms and conditions of the Funding Agreement with the Government of Canada made available to the Members; and
• An Independent Third Party Evaluation to be conducted at least every five years to measure overall performance in achieving the outcomes identified in the Funding Agreements.

Results of evaluation

In 2006, a Mid-Term Performance Evaluation of Canada Health Infoway Inc. was conducted by an external contractor and covered the period from Infoway's inception in 2001 to the winter of 2005. The objective of the Performance Evaluation was "…to conduct a mid-term (formative) evaluation in accordance with a Board-approved framework and timeline as specified in the Funding Agreement". The external evaluation team reached the following conclusions:

• Infoway has achieved results (e.g., Pan-Canadian vision, multi-jurisdictional approaches, specific projects implemented, replication and reuse, and increased capacity in jurisdictions) that would not have been achieved without Infoway;
• Infoway has had positive impacts on iEHR in Canada and there is support for it to complete its work; and
• Infoway has the strategies and organization now in place to complete its work.

Expected outcome

Infoway, according to an independent consulting firm, is "making reasonable progress towards meeting its goal of an interoperable EHR across 50 per cent of Canada (by population) by the end of 2009".

Impact of this policy

Quality of Health Care Services	marginal		fundamental
Level of Equity	system less equitable		system more equitable
Cost Efficiency	very low		very high

References

Sources of Information

BMB Consulting (2006). 2006 Performance Evaluation (Mid-Term): Final Report. Prepared for Canada Health Infoway.

Canada Health Infoway. Available on-line at: www.infoway-inforoute.ca/en/WhoWeAre/Overview.aspx

Canada Health Infoway and the Health Council of Canada (2006). Beyond Good Intentions: Accelerating the Electronic Health Record in Canada. Summary of a Policy Conference Health in Montebello, Quebec, June 11-13, 2006. Available on-line at: www.infoway-inforoute.ca/Admin/Upload/Dev/Document/Conference%20Executive%20Summary_EN.pdf

Canada Health Infoway (2006). Fulfilling the Promise: Canada Health Infoway Inc. Annual Report. Available on-line at: www.infoway-inforoute.ca/Admin/Upload/Dev/Document/Annual%20Report%2005-06%20EN.pdf.

Author/s and/or contributors to this survey

Renée C. Torgerson

Canadian Policy Research Networks

Suggested citation for this online article

Renée C. Torgerson. "Canada Health Infoway". Health Policy Monitor, 10/10/2006. Available at http://www.hpm.org/survey/ca/b8/2